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

20 augustus 2026 bijgewerkt door: 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.

Studie Overzicht

Toestand

Voltooid

Conditie

Interventie / Behandeling

Studietype

Ingrijpend

Inschrijving (Werkelijk)

20

Fase

  • Niet toepasbaar

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

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

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

  • Kind
  • Volwassen

Accepteert gezonde vrijwilligers

Nee

Beschrijving

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

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: Gerandomiseerd
  • Interventioneel model: Crossover-opdracht
  • Masker: Geen (open label)

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Experimenteel: 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.
Experimenteel: 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.
Experimenteel: 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.
Experimenteel: 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.

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Overnight Time in Range (70-180 mg/dL)
Tijdsspanne: 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)

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Mean Overnight Sensor Glucose
Tijdsspanne: 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
Tijdsspanne: 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)
Tijdsspanne: 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)
Tijdsspanne: 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)
Tijdsspanne: 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)
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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)

Medewerkers en onderzoekers

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Sponsor

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start (Werkelijk)

19 november 2020

Primaire voltooiing (Werkelijk)

19 november 2020

Studie voltooiing (Werkelijk)

16 augustus 2021

Studieregistratiedata

Eerst ingediend

13 augustus 2026

Eerst ingediend dat voldeed aan de QC-criteria

20 augustus 2026

Eerst geplaatst (Werkelijk)

21 augustus 2026

Updates van studierecords

Laatste update geplaatst (Werkelijk)

21 augustus 2026

Laatste update ingediend die voldeed aan QC-criteria

20 augustus 2026

Laatst geverifieerd

1 augustus 2026

Meer informatie

Termen gerelateerd aan deze studie

Andere studie-ID-nummers

  • BEDTIME-SNACK-T1D

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

JA

Beschrijving IPD-plan

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.

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Nee

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

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