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Effects of Bedtime Snack Composition on Overnight Glucose in Children and Adolescents With Type 1 Diabetes

20. august 2026 opdateret af: Didem Güneş Kaya

Bedtime Snack Composition and Overnight Glycemic Profiles in Children and Adolescents With Type 1 Diabetes Using Multiple Daily Injections: A Randomized Crossover Study

This study compared four types of bedtime snacks in children and adolescents with type 1 diabetes treated with multiple daily insulin injections. The aim was to determine whether bedtime snack nutrient composition affects overnight glucose levels.

Participants received four different bedtime snacks: carbohydrate alone, carbohydrate with protein, carbohydrate with fat, and carbohydrate with fiber. The order of the four snack types was randomly assigned. Each snack type was consumed at 9:00 PM for three consecutive nights without an additional insulin dose for the snack. All participants received all four snack types during the study.

Overnight glucose levels were measured from 9:00 PM to 9:00 AM using a blinded continuous glucose monitoring system. The primary outcome was the percentage of time glucose levels remained between 70 and 180 mg/dL during the overnight period. Secondary outcomes included measures of hypoglycemia, hyperglycemia, glucose variability, and changes in glucose levels during different periods of the night.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

20

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

    • Fatih
      • Istanbul, Fatih, Tyrkiet (Türkiye), 34098
        • Istanbul University Cerrahpasa-Cerrahpasa Faculty of Medicine

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Barn
  • Voksen

Tager imod sunde frivillige

Ingen

Beskrivelse

Inclusion Criteria:

Age 6-18 years Diagnosis of type 1 diabetes for more than 1 year Completion of the remission period Treatment with multiple daily insulin injections Completion of all three stages of carbohydrate-counting education Ability to perform capillary blood glucose monitoring at least four times daily Total daily insulin dose >0.5 U/kg/day Mean HbA1c <9.6% during the preceding 3 months

Exclusion Criteria:

Insulin pump or sensor-augmented pump therapy Incomplete carbohydrate-counting education Impaired awareness of hypoglycemia Intestinal malabsorption Delayed gastric emptying Celiac disease or any other condition requiring dietary restriction Cystic fibrosis or other gastrointestinal disorders Diabetes-related chronic complications Physical or mental disability limiting adherence to study procedures Eating behavior disorders Active infection

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Crossover opgave
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Sequence 1: CHO First
Participants received the four bedtime snack interventions in the following order: CHO, CHO+PRO, CHO+FAT, and CHO+FIB.
Participants consumed an apple as a carbohydrate-only bedtime snack at 21:00. The snack was consumed within 10 minutes, and no additional bolus insulin was administered for the snack. This intervention was followed for three consecutive nights.
Participants consumed a high-protein fresh cheese bedtime snack containing carbohydrate and protein at 21:00. The snack was consumed within 10 minutes, and no additional bolus insulin was administered for the snack. This intervention was followed for three consecutive nights.
Participants consumed an apple with nuts as a carbohydrate-plus-fat bedtime snack at 21:00. The snack was consumed within 10 minutes, and no additional bolus insulin was administered for the snack. This intervention was followed for three consecutive nights.
Participants consumed rye crispbread as a carbohydrate-plus-fiber bedtime snack at 21:00. The snack was consumed within 10 minutes, and no additional bolus insulin was administered for the snack. This intervention was followed for three consecutive nights.
Eksperimentel: Sequence 2: CHO+PRO First
Participants received the four bedtime snack interventions in the following order: CHO+PRO, CHO+FAT, CHO+FIB, and CHO.
Participants consumed an apple as a carbohydrate-only bedtime snack at 21:00. The snack was consumed within 10 minutes, and no additional bolus insulin was administered for the snack. This intervention was followed for three consecutive nights.
Participants consumed a high-protein fresh cheese bedtime snack containing carbohydrate and protein at 21:00. The snack was consumed within 10 minutes, and no additional bolus insulin was administered for the snack. This intervention was followed for three consecutive nights.
Participants consumed an apple with nuts as a carbohydrate-plus-fat bedtime snack at 21:00. The snack was consumed within 10 minutes, and no additional bolus insulin was administered for the snack. This intervention was followed for three consecutive nights.
Participants consumed rye crispbread as a carbohydrate-plus-fiber bedtime snack at 21:00. The snack was consumed within 10 minutes, and no additional bolus insulin was administered for the snack. This intervention was followed for three consecutive nights.
Eksperimentel: Sequence 3: CHO+FAT First
Participants received the four bedtime snack interventions in the following order: CHO+FAT, CHO+FIB, CHO, and CHO+PRO.
Participants consumed an apple as a carbohydrate-only bedtime snack at 21:00. The snack was consumed within 10 minutes, and no additional bolus insulin was administered for the snack. This intervention was followed for three consecutive nights.
Participants consumed a high-protein fresh cheese bedtime snack containing carbohydrate and protein at 21:00. The snack was consumed within 10 minutes, and no additional bolus insulin was administered for the snack. This intervention was followed for three consecutive nights.
Participants consumed an apple with nuts as a carbohydrate-plus-fat bedtime snack at 21:00. The snack was consumed within 10 minutes, and no additional bolus insulin was administered for the snack. This intervention was followed for three consecutive nights.
Participants consumed rye crispbread as a carbohydrate-plus-fiber bedtime snack at 21:00. The snack was consumed within 10 minutes, and no additional bolus insulin was administered for the snack. This intervention was followed for three consecutive nights.
Eksperimentel: Sequence 4: CHO+FIB First
Participants received the four bedtime snack interventions in the following order: CHO+FIB, CHO, CHO+PRO, and CHO+FAT.
Participants consumed an apple as a carbohydrate-only bedtime snack at 21:00. The snack was consumed within 10 minutes, and no additional bolus insulin was administered for the snack. This intervention was followed for three consecutive nights.
Participants consumed a high-protein fresh cheese bedtime snack containing carbohydrate and protein at 21:00. The snack was consumed within 10 minutes, and no additional bolus insulin was administered for the snack. This intervention was followed for three consecutive nights.
Participants consumed an apple with nuts as a carbohydrate-plus-fat bedtime snack at 21:00. The snack was consumed within 10 minutes, and no additional bolus insulin was administered for the snack. This intervention was followed for three consecutive nights.
Participants consumed rye crispbread as a carbohydrate-plus-fiber bedtime snack at 21:00. The snack was consumed within 10 minutes, and no additional bolus insulin was administered for the snack. This intervention was followed for three consecutive nights.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Overnight Time in Range (70-180 mg/dL)
Tidsramme: 12 hours after bedtime snack consumption (21:00-09:00)
Percentage of continuous glucose monitoring (CGM) readings within the target glucose range of 70-180 mg/dL during the overnight period following each bedtime snack intervention.
12 hours after bedtime snack consumption (21:00-09:00)

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Mean Overnight Sensor Glucose
Tidsramme: 12 hours after bedtime snack consumption (21:00-09:00)
Mean continuous glucose monitoring (CGM) glucose concentration during the overnight period following each bedtime snack intervention.
12 hours after bedtime snack consumption (21:00-09:00)
Percentage of Overnight Time in Tight Range (70-140 mg/dL)vernight Sensor Glucose
Tidsramme: 12 hours after bedtime snack consumption (21:00-09:00)
Percentage of CGM readings within the glucose range of 70-140 mg/dL during the overnight period following each bedtime snack intervention.
12 hours after bedtime snack consumption (21:00-09:00)
Percentage of Overnight Time Below Range (<70 mg/dL)
Tidsramme: 12 hours after bedtime snack consumption (21:00-09:00)
Percentage of CGM readings below 70 mg/dL during the overnight period following each bedtime snack intervention.
12 hours after bedtime snack consumption (21:00-09:00)
Percentage of Overnight Time Below Range (<54 mg/dL)
Tidsramme: 12 hours after bedtime snack consumption (21:00-09:00)
Percentage of CGM readings below 54 mg/dL during the overnight period following each bedtime snack intervention.
12 hours after bedtime snack consumption (21:00-09:00)
Percentage of Overnight Time Above Range (>180 mg/dL)
Tidsramme: 12 hours after bedtime snack consumption (21:00-09:00)
Percentage of CGM readings above 180 mg/dL during the overnight period following each bedtime snack intervention.
12 hours after bedtime snack consumption (21:00-09:00)
Percentage of Overnight Time Above Range (>250 mg/dL)
Tidsramme: 12 hours after bedtime snack consumption (21:00-09:00)
Percentage of CGM readings above 250 mg/dL during the overnight period following each bedtime snack intervention.
12 hours after bedtime snack consumption (21:00-09:00)
Coefficient of Variation of Overnight Sensor Glucose
Tidsramme: 12 hours after bedtime snack consumption (21:00-09:00)
Coefficient of variation of CGM glucose values during the overnight period, expressed as a percentage
12 hours after bedtime snack consumption (21:00-09:00)
Peak Overnight Sensor Glucose
Tidsramme: 12 hours after bedtime snack consumption (21:00-09:00)
Highest CGM glucose concentration recorded during the overnight period following each bedtime snack intervention.
12 hours after bedtime snack consumption (21:00-09:00)
Nadir Overnight Sensor Glucose
Tidsramme: 12 hours after bedtime snack consumption (21:00-09:00)
Lowest CGM glucose concentration recorded during the overnight period following each bedtime snack intervention.
12 hours after bedtime snack consumption (21:00-09:00)
Peak-to-Nadir Overnight Glucose Amplitude
Tidsramme: 12 hours after bedtime snack consumption (21:00-09:00)
Difference between the highest and lowest CGM glucose concentrations during the overnight period following each bedtime snack intervention.
12 hours after bedtime snack consumption (21:00-09:00)
Incremental Area Under the Overnight Glucose Curve
Tidsramme: 12 hours after bedtime snack consumption (21:00-09:00)
Incremental area under the CGM glucose curve during the overnight period following each bedtime snack intervention.
12 hours after bedtime snack consumption (21:00-09:00)
Number of Overnight Hypoglycemic Events
Tidsramme: 12 hours after bedtime snack consumption (21:00-09:00)
Number of hypoglycemic events occurring during the overnight period following each bedtime snack intervention.
12 hours after bedtime snack consumption (21:00-09:00)
Number of Overnight Hyperglycemic Events
Tidsramme: 12 hours after bedtime snack consumption (21:00-09:00)
Number of hyperglycemic events occurring during the overnight period following each bedtime snack intervention.
12 hours after bedtime snack consumption (21:00-09:00)

Samarbejdspartnere og efterforskere

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Sponsor

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

19. november 2020

Primær færdiggørelse (Faktiske)

19. november 2020

Studieafslutning (Faktiske)

16. august 2021

Datoer for studieregistrering

Først indsendt

13. august 2026

Først indsendt, der opfyldte QC-kriterier

20. august 2026

Først opslået (Faktiske)

21. august 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

21. august 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

20. august 2026

Sidst verificeret

1. august 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • BEDTIME-SNACK-T1D

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

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IPD-planbeskrivelse

De-identified individual participant data underlying the results reported in the publication may be shared upon reasonable request, subject to ethical and privacy restrictions and applicable institutional requirements.

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