Isomaltulose is a natural occurring disaccharide composed of alpha-1,6-linked glucose and fructose. Commercial isomaltulose is produced from sucrose by enzymatic rearrangement and has been used as a sugar in Japan since 1985. It is particularly suitable as a non-cariogenic sucrose replacement and is favorable in products for diabetics and prediabetic dispositions. In vivo studies with rats and pigs indicate that isomaltulose is completely hydrolyzed and absorbed in the small intestine. This is supported by in vitro studies showing that intestinal disaccharidases from various species (including man) can hydrolyze isomaltulose. The rate of hydrolysis, however, is very slow compared with sucrose and maltose. Thus, blood glucose and insulin levels in humans after oral administration rise slower and reach lower maxima than after sucrose administration. After absorption, fructose and glucose are metabolized as typical for these monosaccharides. From intravenous studies it can be assumed that any systemic isomaltulose would be hydrolyzed as well, or excreted in urine. In several subchronic toxicity studies, the administration of large doses (up to 7.0 and 8.1 g/kg body weight/day in male and female rats, respectively) of isomaltulose, did not result in adverse effects. Isomaltulose induced neither embryotoxic or teratogenic effects in rat foetuses, nor maternal toxicity at levels up to 7 g/kg body weight/day. Isomaltulose was non-mutagenic in the Ames test. As hydrolysis in the small intestine is complete, even high levels of isomaltulose are well tolerated in animals and humans. In studies with healthy as well as diabetic subjects high doses up to 50 g were tolerated without signs of intestinal discomfort. On the basis of the data reviewed it is concluded that the use of isomaltulose as an alternative sugar is as safe as the use of other digestible sugars consisting of glucose and fructose.