"While we found links to cognitive decline for middle-aged people both with and without diabetes, people with diabetes are more likely to use artificial sweeteners as sugar substitutes," Suemoto said.
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"More research is needed to confirm our findings and to investigate if other refined sugar alternatives, such as applesauce, honey, maple syrup or coconut sugar, may be effective alternatives," she added.
Researchers emphasized that as an observational study, the findings establish a statistical connection rather than direct cause and effect.
Dietary data was self-reported by participants through questionnaires administered at the start of the monitoring period.
The health impact of beverages remains a focus of public health research. Sugar-sweetened drinks represent the largest source of added sugar in the American diet.
A systematic review for the 2025–2030 Dietary Guidelines for Americans associated sugary beverage consumption with increased risks of type 2 diabetes, obesity, and systemic inflammation.
Independent research has also highlighted systemic challenges in beverage science transparency.
A 2016 review led by Dr. Dean Schillinger at the University of California, San Francisco, analyzed 60 studies on sugary drinks and metabolic disease.
All 26 studies reporting no adverse health link were funded by the beverage industry.
"This industry seems to be manipulating contemporary scientific processes to create controversy and advance their business interests at the expense of the public's health," Schillinger said.
Industry advocacy groups maintain that their supported research meets rigorous scientific standards. Health researchers recommend prioritizing plain water and whole foods to minimize potential neurological and metabolic risks.
"We are in a public health war with diabetes right now. In every war there is propaganda...
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we are being played," Schillinger said.
