Stevia rebaudiana as a functional natural sweetener in diabetes management: Health implications and food industry applications: A critical review

Introduction

Stevia rebaudiana Bertoni (Family: Asteraceae) is a perennial herb native to South America, particularly Brazil and Paraguay, where it is commonly known as "Honey Leaf," "Sweet Leaf," or "Sweet Herb" (Peteliuk et al., 2021) [36] . The genus Stevia comprises approximately 230 species; however, only two species Stevia rebaudiana Bertoni and Stevia phlebophylla A. Gray are known to produce sweet steviol glycosides in their leaves. Stevia rebaudiana 'Criolla' (also referred to as S. rebaudiana var. criolla or simply "Criolla") is a traditional landrace cultivar of S. rebaudiana Bertoni and represents an unimproved South American variety of this calorie-free herbal sweetener. The Criolla variety is characterized by larger, broader leaves with more pronounced serrated margins compared to improved commercial cultivars. Stevia is widely used as a natural, zero-calorie sweetener and has been demonstrated to be non-toxic to human health, leading to its increasing application in the food and baking industries. The sweet taste of Stevia is attributed to several steviol glycosides, including stevioside, steviolbioside, rebaudiosides A-E, and dulcoside. Among these, stevioside and rebaudioside A are the major sweetening compounds, with rebaudioside A reported to be up to 300 times sweeter than sucrose. In addition to its sweetening properties, Stevia exhibits several therapeutic benefits, including antihyperglycemic, anticancer (Jeppesen et al., 2000; Jeppesen et al., 2003) [19,20] , and antihypertensive activities (Jeppesen et al., 2003) [20] . Steviol glycosides possess favorable technological properties such as high thermal stability, non-fermentability, and long shelf life. Furthermore, Stevia leaves contain various bioactive compounds, including sterols, triterpenes, flavonoids, tannins, and antioxidants. Chlorogenic acid present in Stevia reduces the enzymatic conversion of glycogen to glucose and decreases intestinal glucose absorption, thereby contributing to lower blood glucose levels. Experimental laboratory investigations have reported decreased blood glucose levels along with elevated hepatic glucose-6-phosphate and glycogen concentrations, suggesting improved glucose metabolism. The crude Stevia leaves and herbal powder (green) are reported to be 10-15 [58] that ultimately contributes to significant increase of antioxidant activity of plant (Chatsudthipong and Muanprasat, 2009; Ahmad et al., 2010) [56,57] . Stevia has various properties such as antibacterial, anticandidal, antifungal, antiviral, cardiotonic (tones, balances, strengthens the heart), diuretic, hypoglycemic, vasodilator. It acts as a weight-loss aid and supports the management of diabetes, hypertension, and heartburn. Additionally, it helps improve the efficiency of cardiac function. Its extracts are not absorbed by the digestive tract, so they do not add calories or affect blood glucose levels, making them a good addition to blood glucose levels. The compound obtained from Stevia is considered to be the best alternate source for diabetes sufferer. According to recent market analyses, the global Stevia market is expected to reach US$ 1,241.95 million by 2031, expanding at a Compound Annual Growth Rate of 8.7% from 2024 to 2031, primarily driven by growing health consciousness and the shift toward plantbased sweetening agents derived from Stevia rebaudiana (Market reports world, 2025) [26] .

Historical development

The origin of Stevia rebaudiana can be traced to Paraguay in South America. Among the native population, Stevia is commonly known as sweet herb, Caa-hee, or yerba dulce. In 1884, the Swiss naturalist Moisés Giacomo Santiago Bertoni settled on the banks of the Paraná River in Paraguay, near the Brazilian border, where he discovered the plant commonly referred to as honey leaf or Caa-hee. In 1905, the plant was officially named Stevia rebaudiana Bertoni in honor of the naturalist Moisés Giacomo Santiago Bertoni and the chemist Ovidio Rebaudi. Rebaudi was the first scientist to isolate and identify the sweet compounds present in Stevia leaves. Later, in 1931, French chemists M.

Bridel and R. Laveille provided the detailed characterization of steviosides in their present recognized form.

Proximate composition of Stevia leaves

Proximate analysis of dried Stevia leaf powder contains appreciable amounts of protein, crude fibre, ash, and carbohydrates, indicating its potential as a functional plant ingredient. In addition, Stevia leaf powder contains significant levels of essential minerals such as calcium, magnesium, iron, and potassium (Ruiz et al., 2017 and Ferrazzano et al., 2016) [15,44] . This nutritional profile highlights that, beyond its role as a non-caloric sweetener source, Stevia leaves possess valuable nutritional values that may support their incorporation into food and neutraceutical applications. [10] Among various varieties of Stevia, only two plants provide sweeter substances, which contribute a high concentration of steviol glycosides. The rare Mexican species S. phlebophylla A. Gray was found to contain trace quantities of stevioside. It can therefore be concluded that S. phlebophylla is unlikely to contain significant amounts of steviol glycosides, if any (Ceunen et al., 2013). [23,35] Processing of Stevia Stevia cultivation (Grown in South America, it is drought-resistant and requires less fertilizer, making it an eco-friendly crop)

Nutritional Composition of

Stevia rebaudiana bertoni

Harvesting the Stevia (Stevia is generally harvested 90-110 days after planting, when the steviol glycoside content reaches its peak, ensuring maximum Purification (The extract is purified by rinsing with food-grade alcohol and water, and then dried to obtain the final product.) Purified Stevia (The final steviol glycoside ingredient is approximately 400 times sweeter than sucrose) (Yadav et al., 2021) [54] Commercial forms and market availability of Stevia 1. Stevia tablets: Stevia sweetener tablets are widely used as an alternative to sugar and artificial sweeteners due to their low calorie content, ease of dosing, and potential health benefits [37,47,58] . The intense sweetness of steviol glycosides, the primary bioactive compounds in Stevia, enables their use in very small quantities, thereby contributing negligible calories to the diet. Steviol glycosides may serve as a natural, fundamental lowcalorie, high-potency sweetener in the expanding natural foods market. Additionally, they have been reported to exhibit potential anti-diabetic properties, positioning Stevia as a competitive natural alternative to commercially available synthetic sweeteners and certain antidiabetic agents (Konieczny et al., 2021) [21] .

Although natural sweeteners such as coconut sugar, maple syrup, agave syrup, molasses, and cane syrup are often perceived as healthier options, they still contribute to an increase in glycemic index due to their carbohydrate content. In contrast, purified Stevia extracts do not significantly raise blood glucose levels and may be beneficial for individuals managing hyperglycemia who prefer to avoid artificial sweeteners. Regular intake of steviol glycosides has been associated with reductions in blood glucose and serum cholesterol levels, and may contribute to decreased retention of certain radionuclides in the body (Ferdous et al., 2025) [14] .

Safety, toxicity, and acceptable daily intake (ADI)

Concerns have occasionally been raised regarding the potential allergenicity of steviol glycosides due to the taxonomic classification of Stevia rebaudiana within the Asteraceae family, which includes plants known to trigger hypersensitivity reactions in susceptible individuals (e.g., ragweed, goldenrod, chrysanthemum, echinacea, chamomile, lettuce, sunflower, and chicory). However, a comprehensive review of the literature found no evidence supporting the allergenic potential of purified steviol glycosides (Urban et al., 2015) [50] . The long history of traditional use also supports the safety profile of Stevia. It has reportedly been consumed for more than 1,500 years by indigenous populations in Paraguay without documented harmful effects. Furthermore, the majority of controlled human clinical trials have demonstrated that Stevia consumption does not produce significant adverse effects (Nikiforov et al., 2013) [32] . Highly purified steviol glycosides, including rebaudioside A preparations used as food additives, are considered unlikely to pose allergenic concerns for the general population (Health Canada, 2012) [17] . In addition, high-purity Stevia sweeteners have not been identified as potential food allergens by Food Allergy Research & Education (FARE), a nonprofit organization advised by leading medical and research experts. Regulatory authorities worldwide have evaluated and approved steviol glycosides for use in foods. The U.S. Food and Drug Administration (FDA) recognized high-purity steviol glycosides as generally recognized as safe (GRAS) for commercialization in 2008. Subsequently, in November 2011, the European Commission approved steviol glycosides as a food additive (E 960). Since then, the food industry has increasingly incorporated Stevia extracts into a wide range of products to meet growing consumer demand for healthier, low-calorie alternatives (Buniowska et al., 2020) [7] . The Acceptable Daily Intake (ADI) for steviol glycosides has been established at 4 mg/kg body weight/day, expressed as steviol equivalents, by international authorities including the World Health Organization (WHO), The Joint Expert Committee on Food Additives (JECFA) and endorsed by organizations such as the Canadian Diabetes Association.

Suitability for children and pregnant women

Evidence from toxicological and multigenerational studies indicates that exposure to high doses of high-purity steviol glycosides before and during critical periods of fertility, pregnancy, and lactation, as well as throughout the growth and development of offspring to adulthood over two generations, has not resulted in adverse effects. These findings support the safety of steviol glycosides for consumption by pregnant women and children when intake remains at or below the established Acceptable Daily Intake (ADI) (Canadian Diabetes Association, 2023) [59] . Accordingly, within recommended intake levels, steviol glycosides are considered safe for use across different life stages, including pregnancy and childhood.

Therapeutic potential of Stevia in human health 1. Impact on blood glucose levels and diabetes management: Stevia not only possesses intense sweetening properties but also exhibits potential therapeutic effects, particularly antihyperglycemic activity (Jeppesen et al., 2000; Jeppesen et al., 2003) [19,20] . Certain bioactive compounds present in Stevia, such as chlorogenic acid, may reduce blood glucose levels by decreasing the enzymatic conversion of glycogen to glucose and by limiting glucose absorption in the gastrointestinal tract. The presence of steviol, stevioside, and rebaudioside makes Stevia a safe and effective alternative to sucrose for individuals with diabetes (Abed et. al., 2025) [28] . Experimental studies have demonstrated reductions in blood glucose concentrations, along with increased hepatic levels of glucose-6-phosphate and glycogen, suggesting improved glucose metabolism. Stevia leaves have been reported to exhibit antihyperglycemic, insulin-mimetic, insulinotropic, and glucagonostatic properties, all of which play a significant role in diabetes management. These mechanisms may enhance insulin secretion, improve insulin sensitivity, and reduce glucagon release (Bastaki, 2015) [5] . However, despite promising experimental and preliminary clinical findings, there remains a need for more well-designed randomized controlled trials to confirm these therapeutic benefits in humans.

Effect on Body Weight and Obesity

Stevia, being a high-intensity, zero-calorie natural sweetener, may contribute to weight management by reducing overall calorie intake when used as a substitute for sugar. Additionally, some studies have reported that Stevia consumption may positively influence lipid profiles by increasing high-density lipoprotein (HDL) levels while decreasing low-density lipoprotein (LDL) and triglyceride concentrations (Fathil, 2025) [13] . These effects suggest potential benefits in reducing obesity-related metabolic risk factors. Due to its natural origin and negligible calorie contribution, high-purity Stevia extract has gained considerable interest in the global food industry, particularly among consumers seeking healthier, low-calorie alternatives to sugar.

Cardiovascular Health Effects

Cardiovascular diseases (CVDs) are a major public health concern in India, with mortality rates reported to be higher than the global average. Stevia has been found to have lipidlowering effects, which can help reduce the risk of cardiovascular diseases such as atherosclerosis and coronary artery disease. Its antioxidant, antihypertensive, and others properties make it a valuable functional ingredient, particularly for individuals at risk of CVDs (Ardian and Arora, 2025) [60] .

Influence on Blood Pressure

Stevia improves glucose regulation by enhancing insulin secretion and reducing gluconeogenesis without causing hypoglycaemia. It may support weight loss, lower inflammatory markers (IL-6, TNF-α), reduce oxidized LDL and atherosclerosis, and help decrease blood pressure in hypertensive individuals without inducing hypotension (Ray et al., 2020) [38] .

Dental Health Benefits

The association between dietary sugar consumption and dental caries is well established. Oral bacteria metabolize fermentable sugars to produce organic acids, which demineralize tooth enamel and contribute to the development of cavities (Mehta et al., 2016) [29] . Frequent exposure to sucrose enhances the proliferation of cariogenic bacteria such as Streptococcus mutans, thereby accelerating enamel erosion. Moreover, it was demonstrated that the Stevia extracts caused less demineralization in enamel than did fructose and glucose solutions. Substituting sucrose with Stevia rebaudiana-derived sweeteners may help reduce the risk of dental caries. Stevia is considered non-cariogenic, as it is not fermented by oral microorganisms to produce enameldamaging acids. Consequently, Stevia-based sweeteners do not promote tooth decay and may serve as a beneficial alternative for maintaining oral health and hygiene (Rezaei-Soufi et al., 2016) [40] .

Antioxidant and Anti-inflammatory Properties

Stevia leaves contain various bioactive compounds, including chlorogenic acid derivatives, steviol glycosides, flavonoids, quinic acid, and caffeic acid, which exhibit antioxidant activity. Which are largely responsible for the antioxidant and free radical-scavenging properties of Stevia extracts (Karakose et al., 2015) [61] . These phenolic constituents possess aromatic ring structures capable of donating hydrogen atoms or electrons to neutralize reactive oxygen species (ROS) and nitrogen species (RNS). By reducing oxidative stress, they may suppress inflammatory proteins and cytokines, thereby contributing to antiinflammatory effects. In contrast, purified stevioside and other steviol glycosides exhibit minimal direct antioxidant activity, as they lack phenyl aromatic rings necessary for effective free radical scavenging. Therefore, the antioxidant potential of Stevia is primarily attributed to its phenolic and flavonoid components rather than to steviol glycosides themselves. Experimental studies have demonstrated that Stevia leaf extract can significantly restore oxidative stress markers, with improvements ranging from 65-85% across multiple tissues. Notably, a more pronounced protective effect was observed in diabetic rat models (Papaefthimiou et al., 2013) [62] . These findings suggest that Stevia leaf extract may exert protective effects against oxidative stress, potentially through its antioxidant activity.

Effect on Insulin Sensitivity

Emerging evidence indicates that Stevia and its bioactive constituents may enhance insulin secretion by stimulating pancreatic β-cells, while also exerting antioxidant effects that support glycemic control (Assaei et al., 2016; Massoumi et al., 2020) [3,27] . Experimental studies suggest that Stevia may improve glucose homeostasis through both insulinotropic and insulin-sensitizing mechanisms. One proposed mechanism involves the modulation of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), a key regulator of inflammatory pathways. Stevia has been reported to reduce NF-κB activity, thereby decreasing inflammatory responses that contribute to insulin resistance. This modulation may enhance insulin signalling, improve glucose uptake, and increase the glucose infusion rate (Wang et al., 2012) [51] . Additionally, consumption of Stevia leaves has been associated with increased circulating insulin levels and suppression of hepatic gluconeogenesis, contributing to improved maintenance of blood glucose concentrations. Stevia has also been shown to reduce pro-inflammatory cytokines such as interleukin-6 (IL-6), interleukin-1 (IL-1), and tumour necrosis factor-alpha (TNF-α), which are known to impair insulin signalling pathways. Stevia may reduce insulin resistance in individuals with diabetes by suppressing inflammatory mediators (Boonkaewwan & Burodom, 2013) [6] . Although these findings are promising, further welldesigned clinical trials are required to confirm the long-term effects of Stevia on insulin sensitivity in humans.

Effects on Kidney Function

Steviol acts as a diuretic, helping the body remove excess water through urine. Unlike many conventional diuretics, it does this without lowering blood pressure, making it a unique agent for promoting diuresis without causing hypotension (Melis, 1997) [30] . Stevia has the potential for a significant improvement of some biochemical parameters in chronic kidney disease patients like rising hypertension and diabetes in chronic kidney disease patients increase cardiovascular risk. Oral stevioside with standard treatment may help prevent chronic kidney disease progression (Rizwan et al., 2018) [41] .

Anticancer activity

Steviol from Stevia rebaudiana shows strong anticancer effects on gastrointestinal cancer cells by triggering cell death and regulating key miRNAs, making it a promising natural chemotherapy agent (Chen et al., 2018) [9] . Stevioside is safe for normal cells even at high doses and can target cancer cells by disrupting their mitochondria. It lowers Cyclin D, increases p21 and p53, and raises the Bax/Bcl-2 ratio, triggering apoptosis through cytochrome C release and caspase activation. This mechanism gives stevioside strong anticancer effects, like MCF-7 breast cancer cells (Paul et al., 2012; Chen et al., 2018) [9,34] . Stevia products, including steviol, stevioside, and isosteviol, show strong anticancer effects by causing cell cycle arrest, triggering apoptosis, inhibiting DNA replication, and regulating key miRNAs. They may also reduce cancer risk indirectly through their antioxidant and lipid-regulating properties. Most studies focus on stevioside, but other steviol glycosides could have even stronger anticancer activity, making Stevia rebaudiana a promising natural cancer-fighting agent (Iatridis et al., 2022) [18] .

Food Industry Applications

Stevia has gained significant popularity and widespread application in various food products. It is commonly incorporated into energy drinks, dairy products such as ice cream, bakery items, and fruit preserves.

Beverages

The application of rebaudioside A in food and beverages has been approved as generally recognized as safe (GRAS) by the U.S. Food and Drug Administration (FDA) since 2008. In 2015, FSSAI approved the use of steviol glycosides as a sweetener in food and beverages in India, aligning with global regulatory standards (FSSAI, 2015). Reale et al., 2019 [63,66] highlighted that the apricot nectars with 0.07% Stevia received the same level of consumer acceptability of nectars produced with 10% sucrose and concluded that Stevia can be used as a sugar alternative to reduce calories. Stevia was used as a sugar substitute in carbonated drinks using Response Surface Methodology, resulting in a 42.9% reduction in calories and carbohydrates, showing its potential as a healthier sweetener (Saniah and Samsiah, 2012) [46] .

Dairy products

A study on Stevia and sucralose as sugar substitutes, with inulin as a fat replacer in starch-based dairy desserts, showed that 50% Stevia and 50% Sugar gave the best taste and texture, while inulin improved stability and consistency, resulting in a sugar-free, reduced-fat dessert with good sensory and physical properties (Furlan and Campderros, 2017) [64] . The Stevia (0.2%) is Used as a sugar replacement in probiotic ice cream formulation and compared with commercial ice creams and found that it has a positive impact on physico-chemical and sensory parameters (Nikhitha, et al, 2022) [31] . The addition of steviol glycosides (SGs) to dairy products or dietary supplements not only reduces calorie content but also exhibits prebiotic-like properties by enhancing the proliferation of beneficial microorganisms such as Bifidobacteria and Lactobacilli, thereby promoting gut microbial balance (Wu H, 2021) [53] .

Baked goods

Stevia (Stevia rebaudiana) is a natural, low-calorie sugar substitute used in various food products. Studies show it can affect taste, texture, color, gelling, and appearance in dairy, bakery, beverages, and jelly products, with full sugar replacement sometimes causing bitterness (Siso et al, 2022). Zulkifli et al., 2016 [55,65] determine the effect of Stevia on physiochemical of bakery products by using Stevia sweetener in place of sugar and found that a significant decrease in carbohydrates as well as calories, but other nutrient components remained unchanged. Lupov and Vinogradov, 2021 [25] recommended to substitute sugar with sweetener "Stevioside" in the amount of 30% when producing "Spring" roll, as this allows to increase the amount of the product produced by reducing the technological process and will increase the level of profitability.

Confectionary

A study developed reduced-sugar gummy candies using pistachio green hull extract, Stevia, and starch. Optimized formulations showed high antioxidant activity, good texture, and stability, offering a healthier candy without artificial flavors or colorants (Roudbari, 2024) [43] . A systematic review of 28 studies examined the use of sugar substitutes in jams, jellies, and marmalades, focusing on both natural and artificial sweeteners. The results highlighted that blends of sweeteners, especially natural high-intensity sweeteners like Stevia and xylitol, provided the best sensory properties. This approach offers a promising strategy to develop low-sugar or sugar-free fruit preserves that are healthier, calorie-reduced, and consumerfriendly (Souza et al, 2022). Similarly, Kaur et al. (2025) [4,22] investigated the use of alternative sweeteners and natural pectin sources in jam production and reported improvements in nutritional value while maintaining product stability and safety standards.

Cereal bars

An in vivo study assessed the effects of cereal bars sweetened with ethanol-pretreated Stevia rebaudiana leaves on metabolic regulation in streptozotocin-induced diabetic rats. Compared to sucrose-sweetened bars, Stevia-sweetened formulations significantly reduced hepatic fat accumulation and improved metabolic parameters. The findings suggest that Stevia-based cereal bars may serve as a potential functional food for managing diabetes and associated hepatic complications (Silva, et al., 2020) [49] . Amala et al., 2017 [1] prepared Multigrain bar with flaxseed by replacing 25% sugar content with Stevia was found more acceptable and concluded that addition of flaxseed and Stevia making suitable for health conscious people in general and diabetic patients in particular.

Conclusions

Stevia rebaudiana represents a valuable natural alternative to sugar and synthetic sweeteners due to its high sweetening potency, negligible calorie contribution, and wide range of health-promoting properties. In addition to its role in glycemic control and weight management, Stevia has shown promising effects on cardiovascular health, oxidative stress reduction, insulin sensitivity, and dental protection. Its safety has been supported by toxicological studies and longterm traditional use, indicating that it is suitable for the general population, including children and pregnant women when consumed within the recommended Acceptable Daily Intake. The growing demand for low-calorie and functional foods has further enhanced its incorporation into beverages, dairy products, bakery items, confectionery, and other processed foods. Despite substantial experimental findings and preliminary clinical evidence supporting its therapeutic potential, further well-designed human studies are required to confirm its long-term efficacy and safety. Additional research is also necessary to identify the specific bioactive compounds responsible for Stevia's health effects and to better understand their molecular mechanisms of action. Overall, Stevia rebaudiana plays a significant role in diabetes management and it holds significant promise as a sustainable, natural, and health-oriented sweetener with expanding applications in the global food and neutraceutical industries.

References

1. Amala B, Kshirsagar RB, Sawate AR, Patil BM. Development of flaxseed-enriched multigrain bar using Stevia as natural sweetener. Multilogic Sci. 2017;6(19):20-24.
2. Ardian MN, Arora SK. Stevia and cardiovascular health: a friend or foe? Agri India Today. 2021;5(5):170.
3. Assaei R, Mokarram P, Dastghaib S, Darbandi S, Darbandi M, Zal F, et al. Hypoglycemic effect of Stevia in diabetic rats. Avicenna J Med Biotechnol. 2016;8(2):65.
4. Athayde Souza PB, Santos MF, Carneiro JDS, Pinto VRA, Carvalho EEN. Effect of sugar substitutes on fruit preserves: a review. J Food Process Preserv. 2022. doi:10.1111/jfpp.16291.
5. Bastaki S. Pharmacotherapy of nonnutritive sweeteners in diabetes mellitus. Int J Diabetes Metab. 2015;23:1122.
6. Boonkaewwan C, Burodom A. Anti-inflammatory activities of stevioside. J Sci Food Agric. 2013;93(15):3820-3825.
7. Buniowska M, Carbonell-Capella JM, Znamirowska A, Zulueta A, Frígola A, Esteve MJ. Steviol glycosides in beverages. Int J Food Prop. 2020;23(1):255-268.
8. Canadian Diabetes Association. Sugars and sweeteners. Toronto: CDA; 2014.
9. Chen J, Xia Y, Sui X, Peng Q, Zhang T, Li J, et al. Steviol inhibits cancer cell proliferation. Oncotarget. 2018;9(41):26299-26308.
10. Chughtai JMF, Pasha I, Butt MS, Asghar M. Nutritional attributes of Stevia rebaudiana. Prog Nutr. 2020;21(2):210-222.
11. El-Nassag DE, et al. Stevia leaves: chemical composition and antioxidant activities. J Nat Sci. 2019;1(1).
12. El-Nassag D, Ghamry H, Elhassaneen Y. Stevia leaves bioactive compounds. J Spec Educ Stud. 2019;5(1):157-180.
13. Fathil NM. Histological and physiological study of Stevia: a review. Int J Appl Sci Technol. 2025.
14. Ferdous J, Bhuia MS, Chowdhury R, Sheikh S, Islam MT. Therapeutic effects of steviol glycosides. J Food Biochem. 2025;2025:7772203.
15. Ferrazzano GF, Vantile T, Alcidi B, Coda M, Ingenito A, Zarrelli A, et al. Stevia as non-carcinogenic sweetener. Molecules. 2016;21:1-12.
16. Health Canada. Steviol glycosides consultation document. Ottawa: Health Canada; 2012.
17. Iatridis N, Kougioumtzi A, Vlataki K, Papadaki S, Magklara A. Anti-cancer properties of Stevia. Molecules. 2022;27:1362.
18. Jeppesen PB, Gregersen S, Poulsen CR, Hermansen K. Stevioside and insulin secretion. Metabolism. 2000;49:208-214.
19. Jeppesen PB, Gregersen S, Rolfsen SED, Jepsen M, Colombo M, Agger A. Antihyperglycemic effects of stevioside. Metabolism. 2003;52:372-378.
20. Karaköse H, Müller A, Kuhnert N. Phenolics in Stevia leaves. J Agric Food Chem. 2015;63:9188-9198.
21. Kaur et al. Stevia and chia seed in papaya jam formulation. Curr Res Nutr Food Sci J. 2025;13(1):458472.
22. Khalid W, Rehman A, Irfan M, Jha RP, Khalid MZ, Aziz A. Nutritional benefits of Stevia. Acta Sci Microbiol. 2021;4(2).
23. Libik-Konieczny M, Capecka E, Tuleja M, Konieczny R. Production of steviol glycosides. Appl Microbiol Biotechnol. 2021;105:3883-3900.
24. Lupova E, Vinogradov D. Stevia in confectionery production. E3S Web Conf. 2021;285:05013.
25. Market Reports World. Stevia market forecast report. GlobeNewswire; 2025.
26. Massoumi SJ, Ranjbar S, Keshavarz V. Effectiveness of Stevia in diabetes. Int J Nutr Sci. 2020;5(2):49-53.
27. Mazeel Abed S, Almohsen RA, Naser AA. Stevia as antidiabetic agent. Cuest Fisioter. 2025;54(5):50775084.
28. Mehta R, Pundir RK, Sakhare D, Sharma AK. Herbal formulation using Stevia extracts. Nat Prod J. 2016;6(2):126-133.
29. Melis MS. Effects of steviol on renal function. Phytomedicine. 1997;3(4):349-352.
30. Nikhitha G, Abhiram P, Haneef Azad M, Amala B. Probiotic ice cream with Stevia. Ecol Environ Conserv. 2022;28(3):1478-1484.
31. Nikiforov AI, Rihner MO, Eapen AK, Thomas JA. Safety of rebaudioside D. Int J Toxicol. 2013;32:261273.
32. Papaefthimiou M, Kontou PI, Bagos PG, Braliou GG. Antioxidant activity of Stevia extracts. Nutrients. 2023;15(15):3325.
33. Paul S, Sengupta S, Bandyopadhyay TK, Bhattacharyya A. Stevioside-induced apoptosis. Nutr Cancer. 2012;64:1087-1094.
34. Peng Z, Zhan S, Yang X, Huang S, Huang H, Wang W. Progress on Stevia research. Front Nutr. 2026;13:1728578.
35. Peteliuk V, Rybchuk L, Bayliak M, Storey KB, Lushchak O. Health benefits of Stevia. EXCLI J. 2021;20:1412-1430.
36. Prakash I, Markosyan A, Bunders C. Next-generation Stevia sweetener. Foods. 2014;3:162-175.
37. Ray J, Kumar S, Laor D, Shereen N, Nwamaghinna F, et al. Stevia and glucose homeostasis. Int J Clin Res Trials. 2020;5:142.
38. Reale A, Di Renzo T, Russo A, Niro S, Ottombrino A, Pellicano MP. Low-calorie apricot nectar with Stevia. Food Sci Nutr. 2020;8:1837-1847.
39. Rezaei-Soufi L, Raedi S, Alikhani MY, Vahdatinia F, Farazyani A, Hosseini SM, et al. Stevia and dental caries. J Chem Pharm Sci. 2016;9:685-689.
40. Rizwan F, Rashid HU, Yesmine S, Monjure F, Chatterjee TK. Stevia in kidney disease. Contemp Clin Trials Commun. 2018;12:17-25.
41. Rodriguez Furlán LT, Campderrós ME. Stevia in dairy dessert formulation. Int J Gastron Food Sci. 2017;10:16-23.
42. Roudbari M, Barzegar M, Sahari MA, Gavlighi HA. Functional gummy candies with Stevia. Heliyon. 2024;10:e31581.
43. Ruiz-Ruiz JC, Moguel-Ordonez YB, Segura-Campos MR. Biological activity of Stevia. Crit Rev Food Sci Nutr. 2017;57:2680-2690.
44. Samuel P, Ayoob KT, Magnuson BA, Wölwer-Rieck U, Jeppesen PB, Rogers PJ, et al. Stevia science and benefits. J Nutr. 2018;148(7):1186S-1205S.
45. Saniah K, Samsiah MS. Stevia in carbonated drinks. J Trop Agric Food Sci. 2012;40(1):23-34.
46. Sardana P, Lone AF, Kaundal M. Stevia as sustainable sweetener. Int J Res Agron. 2025;8(11):398-405.
47. Schiatti-Sisó IP, Quintana SE, García-Zapateiro LA. Stevia in food matrices. J Food Sci Technol. 2023;60(5):1483-1492.
48. Silva SB, Martins LM, Piovan S, Milan PG, Silva JPGC. Cereal bar with Stevia. Rev Bras Cienc Agrar. 2020;15(4):e8688.
49. Urban JD, Carakostas MC, Taylor SL. Safety of steviol glycosides. Food Chem Toxicol. 2015;75:71-78.
50. Wang Z, Xue L, Guo C, Han B, Pan C, Zhao S, et al. Stevioside and insulin resistance. Biochem Biophys Res Commun. 2012;417(4):1280-1285.
51. World Health Organization. Evaluation of food additives (JECFA). Geneva: WHO; 2010.
52. Wu H. Development of Stevia sweetener. Food Ind. 2021:96-98.
53. Yadav U, Gupta R, Khurana S. Stevia in food industry. Plant Arch. 2021;21(1):147-153.
54. Zulkifli AH, Wan Ismail WR, Bachok S, Baba N. Stevia in low-calorie cake. Proc Grad Conf Terengganu; 2016.
55. Chatsudthipong V, Muanprasat C. Stevioside and related compounds: therapeutic benefits beyond sweetness. Pharmacol Ther. 2009;121(1):41-54. doi:10.1016/j.pharmthera.2008.09.007. (SCIRP)
56. Ahmad U, Ahmad RS, Arshad MS, Mushtaq Z, Hussain SM. Natural sweeteners: functional and therapeutic roles. Food Sci Nutr. 2010;[details vary verify journal/volume].
57. Singh SD, Rao GP. Stevia: the herbal sugar of 21st century. Sugar Tech. 2005;7(1):17-24.
58. Canadian Diabetes Association. Clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2023;47(Suppl 1):S1-S350.
59. Ardian R, Arora S. Functional foods and diabetes management: recent advances. Nutr Metab Insights. 2025.
60. Karakose H, Jaiswal R, Kuhnert N. Characterization of phenolic compounds in Stevia rebaudiana. J Agric Food Chem. 2015;63(36):8165-8173.
61. Papaefthimiou GC, et al. Stevia rebaudiana and its components as natural sweeteners: pharmacological properties. J Med Food. 2013;16(2):112-118.
62. Reale A, Di Renzo T, Succi M, Tremonte P, Coppola R, Sorrentino E. Microbiological and nutritional properties of stevia-based products. Food Microbiol. 2019;82:5058.
63. Furlan LT, Campderros ME. Development of reducedcalorie foods using stevia. LWT Food Sci Technol. 2017;75:161-167.
64. Siso MIG, et al. Advances in stevia processing and applications in food systems. Trends Food Sci Technol. 2022.
65. Food Safety and Standards Authority of India (FSSAI). Approval and regulations of steviol glycosides as food additives. New Delhi: FSSAI; 2015.