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MANUSCRIPT 

Splenda and Health Disparities: Examining 

its Effects on Adults with Type 2 Diabetes in 

the Texas-Mexico Border 
 

Marisol Acosta1, Mariajose Garza1,2, Ana Gutierrez1,2, Ozzie Herrera1,3, Luz Lieu1,3, Deborah Orieukwu1,3, 

Jeremias Rivas1,3 

 

1   DHR Health High School and Community Outreach  
2  South Texas ISD Medical Professions 
3 South Texas ISD Health Professions 

 

Received: July 3, 2024  

Accepted for publication: January 24, 2025    

Introduction 

This literature review investigates the complex relationship between sucralose (Splenda), a 

widely used artificial sweetener, and health disparities among adults with type 2 diabetes (T2D) 

in the Texas-Mexico border region. The review explores the interplay of factors contributing to 

the disproportionate burden of T2D and its complications in this population while examining 

Splenda's potential role in exacerbating or mitigating these health challenges. Sucralose, a 

chlorinated sucrose derivative, is approximately 600 times sweeter than sucrose and is largely 

excreted unchanged in urine. This characteristic has led to its promotion as a calorie-free 

alternative to sugar. However, the long-term health effects of sucralose, especially in vulnerable 

populations like those with T2D, remain a subject of ongoing debate. This review will synthesize 

existing research on Splenda's effects on metabolic health, critically evaluate studies examining 

health disparities in the border region, and investigate the potential interaction between Splenda 

consumption and the various factors contributing to those disparities. 

Health Disparities in the Texas-Mexico Border Region  

The Texas-Mexico border region is characterized by significant health disparities, particularly 

among Latino populations.1-3  These disparities manifest as higher rates of chronic diseases like 

T2D, limited healthcare access, lower socioeconomic status, and cultural and linguistic barriers 

to healthcare navigation.4-6  The binational nature of the region further complicates healthcare 

access, with many residents utilizing healthcare systems in both the United States and Mexico.2  

This complex interplay of socioeconomic, cultural, and geographical factors creates a 



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challenging context for examining the health effects of dietary choices, including artificial 

sweetener consumption.7  

Poverty is a pervasive issue, with a substantial portion of the population below the federal 

poverty level.3.5-6 This impacts access to nutritious food, safe housing, and reliable 

transportation.1,5 The region also faces challenges related to access to clean water and sanitation.5 

The significant presence of undocumented immigrants creates additional barriers to healthcare 

access due to fear of deportation and lack of legal protection.2,6 Limited culturally competent 

healthcare providers and language barriers further complicate the issue.1,7 Cultural norms and 

beliefs influence health behaviors and healthcare-seeking.7,8 The cumulative effect of these social 

determinants creates a cycle of poor health outcomes.3,9 

The Texas-Mexico border region exhibits alarmingly high rates of diabetes and related chronic 

diseases.4,5,10 T2D is significantly prevalent among Latinos in this area, often linked to poor 

dietary habits, limited physical activity, and genetic predispositions.4,5 This high prevalence 

contributes to increased rates of cardiovascular disease, kidney disease, and other diabetes-

related complications.4,11 Obesity, a major risk factor for several cancers and T2D, is another 

significant health concern.5,12  The high rates of these chronic diseases place a substantial burden 

on individuals, families, and the healthcare system.4,13 The high rate of uninsured individuals 

further exacerbates these issues, limiting access to preventative care and timely treatment.2-3,6 

Several factors hinder access to quality healthcare and nutritional education. Financial 

constraints are a major barrier, with many individuals lacking health insurance or facing high 

out-of-pocket costs.2-3,5 Limited access to transportation makes it difficult to reach healthcare 

facilities and participate in educational programs.1,4 Language barriers also present a significant 

challenge, as many individuals may not be fluent in English.4,7 Cultural barriers, including 

mistrust of the healthcare system and differing cultural beliefs about health and illness, further 

complicate access to care.7-8 The lack of culturally tailored health education programs further 

limits the effectiveness of preventative measures.12 The fragmented nature of the healthcare 

system, with limited access to specialists and integrated care, makes it challenging to manage 

chronic conditions effectively.9,10 The lack of adequate resources, both financial and human, 

within the healthcare system often limits the capacity to provide comprehensive care and 

effective health education programs.6,10 This is further compounded by the increasing demand for 

services in a region already experiencing significant shortages of healthcare professionals, 

particularly specialists.10 

Impact of Artificial Sweeteners on Health 

Artificial sweeteners have become increasingly prevalent as low-calorie alternatives to sugar. 

While their use is driven by weight management and reduced caloric intake, their long-term health 

implications remain a subject of debate. This section reviews the literature on the effects of 



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artificial sweeteners, focusing on their impact on metabolic health, glycemic control, and potential 

risks associated with long-term consumption. 

Numerous studies have investigated the effects of artificial sweeteners on various aspects of 

metabolic health. These studies have employed diverse methodologies, including randomized 

controlled trials (RCTs) and observational studies, leading to a complex and sometimes 

contradictory body of evidence.14-15 Some research suggests a potential link between artificial 

sweetener consumption and adverse metabolic outcomes, such as an increased risk of stroke, 

coronary heart disease, and mortality.14 However, observational studies cannot definitively 

establish causality. Other studies have found no significant association between artificial 

sweetener use and negative metabolic effects.15 The discrepancies may be due to differences in 

study design, participant populations, types and amounts of artificial sweeteners consumed, and 

the duration of consumption. 

Sucralose, often marketed as a suitable alternative for individuals with diabetes due to its 

negligible impact on blood glucose levels, is a widely used artificial sweetener. While acute 

studies show minimal effect on immediate blood glucose, the long-term effects on glycemic 

control remain less clear. Some research suggests that regular consumption may affect gut 

microbiota composition and function, potentially altering metabolic processes and influencing 

insulin sensitivity.16 This could indirectly affect glycemic control, although the mechanisms and 

extent of this influence need further investigation. Some evidence suggests that long-term 

consumption could contribute to insulin resistance, potentially impairing glycemic control.14  

However, other studies have not found a clear link between artificial sweetener use and changes 

in insulin sensitivity or HbA1c levels. 

Concerns remain regarding potential long-term health risks associated with artificial sweeteners. 

These include potential adverse cardiovascular events and disruptions to the gut microbiota, 

leading to metabolic disturbances.14,16 Some research suggests a potential link between artificial 

sweetener consumption and certain cancers, although more research is needed to establish a 

definitive causal relationship. Another critical area of concern is the potential impact on weight 

management. While artificial sweeteners are often used to aid weight loss, some studies have 

reported a paradoxical association between artificial sweetener consumption and weight gain.14 

This may be due to several mechanisms, including altered gut microbiota, increased appetite, and 

changes in energy balance. The impact of artificial sweetener consumption on kidney function 

and the risk of chronic kidney disease is currently unclear. The majority of research on artificial 

sweeteners focuses on their direct effects, often overlooking the complex interplay between 

dietary habits, lifestyle factors, and overall health. Future research should prioritize studies that 

consider these interactions to provide a more comprehensive understanding of the long-term 

health implications of artificial sweeteners. 

  



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Cultural Considerations  

The cultural nuances surrounding sweetener consumption, particularly Splenda, and their 

implications for health behaviors among adults with T2D in the Texas-Mexico border region. 

Understanding these cultural factors is crucial for designing effective and culturally sensitive 

interventions to improve diabetes management. We will explore cultural attitudes towards 

sweeteners and dietary habits within the Latino population, the influence of acculturation on 

dietary choices and health behaviors, and strategies for developing health education interventions 

that resonate within the specific cultural contexts of this border region. 

The Latino population encompasses a vast array of cultural groups, each with unique traditions 

and dietary practices.8 Traditional Latino diets often incorporate naturally sweet foods like fruits 

and honey, but the increasing availability and marketing of processed foods and sugar-sweetened 

beverages have significantly altered dietary habits.8 This shift is particularly pronounced in urban 

areas and among more acculturated populations.8 The preference for specific sweeteners, 

including the acceptance or rejection of artificial sweeteners like Splenda, is likely influenced by 

various factors, including taste preferences, perceived health benefits, and cultural beliefs about 

food and health.8 Studies examining the specific perceptions and attitudes toward Splenda 

amongst different Latino subgroups within the border region are limited, highlighting a critical 

gap in the current research.8 

Acculturation significantly shapes dietary choices and health behaviors among Latinos in the 

U.S.-Mexico border region.8 Less acculturated individuals may maintain traditional diets higher 

in fruits and vegetables, while more acculturated individuals may adopt diets more similar to 

those of the mainstream American population, often characterized by higher consumption of 

processed foods, sugar-sweetened beverages, and artificial sweeteners.8 This shift in dietary 

habits can contribute to an increased risk of T2D and related complications.8 The impact of 

acculturation on the use of artificial sweeteners like Splenda requires further investigation.8 

Acculturation can also affect other health behaviors, including access to and utilization of 

healthcare services.2 Language barriers, cultural beliefs about healthcare, and immigration status 

can all influence the extent to which individuals seek medical care and adhere to treatment 

plans.2,7 

Developing effective health education interventions requires careful consideration of cultural 

contexts. 12 Interventions must be culturally sensitive and tailored to address the specific needs 

and beliefs of the target population.12 This includes using appropriate language, employing 

culturally relevant communication strategies, and incorporating culturally sensitive educational 

materials.12 The design of interventions should reflect an understanding of the cultural attitudes 

towards sweeteners and dietary habits within the specific Latino subgroups of the border 

region.12 The role of family and community in health decision-making should also be 

considered.7 Interventions should incorporate the family and community as partners in promoting 

healthy behaviors.7 Addressing potential health literacy challenges is also crucial.6 Health 



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education materials should be clear, concise, and easy to understand.6 The broader 

socioeconomic context must be considered.5 Interventions should address these broader social 

determinants of health in addition to focusing on individual behaviors.5 

Methodological Approaches for Assessing Effects  

This section examines the methodological approaches used in research assessing the effects of 

sucralose (Splenda) on health outcomes, particularly its impact on adults with T2D in the Texas-

Mexico border region. A critical evaluation of these methods is crucial for understanding the 

strengths and limitations of existing evidence and identifying areas requiring further 

investigation. The review will address the types of research designs used, the importance of 

longitudinal studies for capturing long-term effects, and the value of mixed-methods approaches 

for incorporating qualitative data on patient experiences. 

Studies investigating the effects of Splenda on health have utilized a range of methodologies, 

including randomized controlled trials (RCTs) and observational designs, such as cohort studies 

and case-control studies.14-15,17-18 RCTs are considered the gold standard for establishing causality, 

but they often have limitations in terms of generalizability, particularly when studying specific 

populations like those in the Texas-Mexico border region.8 Furthermore, the duration of many 

RCTs is relatively short, limiting their ability to assess long-term effects.17 Observational studies 

are useful for investigating long-term effects and exploring multiple risk factors, but they cannot 

definitively establish causality due to the presence of potential confounding variables.14  

Longitudinal studies, which track participants over time, are crucial for understanding the 

cumulative effects of Splenda consumption and the potential development of chronic diseases.15 

Longitudinal studies can help elucidate how Splenda consumption interacts with other factors, 

such as access to healthcare, diet, and lifestyle, to influence health outcomes in this vulnerable 

population.8 Mixed-methods approaches, which integrate quantitative and qualitative methods, 

can provide a more comprehensive understanding by incorporating patients' lived experiences 

and perspectives.19 Qualitative data, such as in-depth interviews or focus groups, can provide rich 

insights into how Splenda use affects individuals' daily lives, their perceptions of its effects, and 

their decision-making processes regarding its consumption.7 In the context of the Texas-Mexico 

border region, a mixed-methods approach is particularly valuable for addressing cultural factors 

and health disparities.8 

Several methodological gaps remain. Many studies lack sufficient sample sizes, limiting the 

statistical power and generalizability of their findings.19 Furthermore, the studies often fail to 

adequately account for confounding variables, making it difficult to isolate the effects of 

Splenda. Future research should prioritize larger, well-designed longitudinal studies that 

incorporate mixed-methods approaches to address these limitations.8 These studies should 

specifically address the unique context of the Texas-Mexico border region, considering the 

socioeconomic, cultural, and healthcare access factors that influence diabetes management and 



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Splenda use.8 Studies should focus on developing and validating culturally appropriate 

assessment tools and questionnaires to ensure accurate data collection in this diverse 

population.19 

Conclusion  

This literature review examined the effects of Splenda on the health of adults with Type 2 

Diabetes (T2D) in the Texas-Mexico border region. The lack of direct research on Splenda in 

this specific context highlights a critical gap in the current literature, underscoring the need for 

future investigations. 

The reviewed studies reveal a complex interplay of factors influencing diabetes management and 

outcomes in the Texas-Mexico border region. High rates of T2D among Latinos in this area are 

well-documented, and these disparities are linked to several factors, including socioeconomic 

status, access to healthcare, language barriers, and a lack of social and environmental support for 

disease management. The studies highlight the significant challenges faced by this population, 

including limited health insurance coverage, insufficient provider capacity, and barriers related 

to transportation, cost, and fear of deportation. These challenges are exacerbated by the unique 

binational environment of the region, where access to healthcare in Mexico may be a factor for 

some individuals. Additionally, the influence of environmental factors, such as proximity to 

industrial sites, may further contribute to health disparities. 

The existing research on artificial sweeteners presents both potential benefits and risks. Some 

studies suggest that artificial sweeteners may aid in weight management and not directly impact 

blood glucose levels, which could be beneficial for managing T2D. However, other research 

raises concerns about potential negative impacts on gut microbiota, insulin sensitivity, and even 

weight gain. The long-term effects of artificial sweeteners remain unclear, and conflicting 

findings highlight the need for more research. The absence of research directly investigating 

Splenda's impact on the metabolic health of adults with T2D in this specific border region leaves 

a significant gap in our understanding. This gap is particularly concerning given the already 

existing health disparities within this vulnerable population. 

 Several crucial areas require further investigation. First, a dedicated study is needed to 

specifically assess the effects of Splenda consumption on adults with T2D in this region. This 

study should consider the unique socioeconomic and environmental factors affecting this 

population. The study design should account for potential confounding variables, such as diet, 

lifestyle, access to healthcare, and other health conditions, to isolate the effects of Splenda. 

Second, research should explore the potential interaction between Splenda consumption and the 

gut microbiome within this population. The gut microbiome plays a critical role in metabolic 

health, and alterations to its composition could significantly impact diabetes management. This 

research should employ advanced techniques to analyze the gut microbiome's composition and 

function in response to Splenda consumption. Third, research should investigate the long-term 



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effects of Splenda consumption on cardiovascular health and other diabetes-related 

complications in this population. The existing literature on artificial sweeteners shows 

conflicting results regarding their long-term effects, and this needs clarification specifically in 

the context of the Texas-Mexico border region. Longitudinal studies are necessary to track the 

health outcomes of individuals consuming Splenda over an extended period. Fourth, qualitative 

research methods could provide valuable insights into the perspectives and experiences of 

individuals with T2D in this region regarding their dietary choices and perceptions of artificial 

sweeteners. Understanding the cultural context and social determinants of health is crucial for 

designing effective interventions. Finally, comparative studies are needed to assess the relative 

effectiveness of Splenda versus other sweeteners or dietary approaches in managing T2D within 

this population. This will help determine if Splenda offers any advantages or disadvantages 

compared to other options. 

Given the existing health disparities and the lack of specific research on Splenda's effects in the 

Texas-Mexico border region, healthcare practitioners should exercise caution when 

recommending artificial sweeteners to their patients with T2D. While some individuals might 

find artificial sweeteners helpful for managing weight or improving glycemic control in the short 

term, the long-term consequences remain uncertain. Healthcare providers should prioritize a 

holistic approach to diabetes management, emphasizing lifestyle modifications such as dietary 

changes, physical activity, and stress management. It's crucial to consider individual patient 

needs and preferences while providing personalized dietary guidance. Patients should be 

educated about the potential benefits and risks of various dietary options, including artificial 

sweeteners. Healthcare providers should also address the broader social determinants of health 

that influence dietary choices and diabetes management, such as access to healthy foods, 

socioeconomic factors, and cultural beliefs.  

Furthermore, they should actively work to improve access to comprehensive diabetes care, 

including culturally sensitive education and support programs, for this vulnerable population. 

Given the high prevalence of diabetes and the existing health disparities in the Texas-Mexico 

border region, a multi-faceted approach is essential to effectively manage and prevent this 

chronic disease. The integration of culturally tailored interventions, alongside efforts to address 

social determinants of health, is vital to improving diabetes outcomes and promoting health 

equity in this region. Until more research is available specifically on Splenda's impact within this 

population, a cautious and comprehensive approach to diabetes management is paramount. 

Acknowledgements: 

Nori Zapata, MSN, RN, Senior Vice President of Education and Career Development, Vanessa 

Vera, MS, Senior Manager of High School and Community Outreach, Anisa Mirza, Intern 

Program Coordinator.  

  



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Funding: 

Funded  by  DHR  Health High School and Community Outreach;    DHR    Health; South Texas 

Independent School District.  

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