Effects of Bedtime Snack Composition on Overnight Glucose in Children and Adolescents With Type 1 Diabetes
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
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Faktiske)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiesteder
-
-
Fatih
-
Istanbul, Fatih, Tyrkiet (Türkiye), 34098
- Istanbul University Cerrahpasa-Cerrahpasa Faculty of Medicine
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Barn
- Voksen
Tager imod sunde frivillige
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
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Crossover opgave
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / 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
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
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)
|
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Percentage of Overnight Time Below Range (<54 mg/dL)
Tidsramme: 12 hours after bedtime snack consumption (21:00-09:00)
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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)
|
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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)
|
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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)
|
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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)
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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
Sponsor
Sponsor
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Faktiske)
Primær færdiggørelse
Studieafslutning (Faktiske)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- BEDTIME-SNACK-T1D
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