Bedtime snacking and glycemic deterioration in young children with Type 1 diabetes on multiple daily injections: a randomized controlled crossover trial.

2025-11-21
Nutrition & diabetes 15(1)
- Tuğba Gökçe
- Kağan Ege Karakuş
- Gül Yeşiltepe Mutlu
- Serra Muradoğlu
- Elif Eviz
- Ecem Can
- Carmel Smart
- Şükrü Hatun
- Hülya Gökmen Özel

PubMed: 41271622
DOI: 10.1038/s41387-025-00392-9

Study Design

Type: Randomized Controlled Trial (RCT)
Sample size: n = 28
Population: 5-8-year-old children with T1D using multiple daily injection therapy
Methods: Randomized controlled crossover trial; 10 grams of carbohydrate (milk, yoghurt, and kefir) given 150-180 minutes after dinner over three nights
Blinding: Open-label
Duration: three nights

Objective

To determine if a bedtime snack in young children with type 1 diabetes (T1D) prevents nocturnal hypoglycemia, and the impact on glycemia overnight.

Methods

In this randomized controlled crossover trial, 10 grams of carbohydrate (milk, yoghurt, and kefir) was given 150-180 minutes after dinner over three nights to 5-8-year-old children with T1D using multiple daily injection therapy. Continuous glucose monitoring (CGM) data were collected for 6 hours following the snacks on one control and three snack nights. Time in 70-180 mg/dL (3.9-10 mmol/L) range (TIR), time below 70 mg/dL (3.9 mmol/L) (TBR), and other metrics were analyzed according to international CGM consensus. Trial day was terminated if blood glucose exceeded 300 mg/dL (16.7 mmol/L) or fell below 70 mg/dL (3.9 mmol/L).

Results

Of 28 children (13 female, mean age 6.6 ± 0.8 years, HbA1c 7.0 ± 0.5% (53 mmol/mol)), mean glucose values before the test snacks were 137.8 ± 14.5 mg/dL (7.7 ± 0.8 mmol/L) for milk, 141.9 ± 16.9 mg/dL (7.9 ± 0.9 mmol/L) for yoghurt, 136 ± 19.1 mg/dL (7.6 ± 1.1 mmol/L) for kefir, and 140.8 ± 17.0 mg/dL (7.8 ± 0.9 mmol/L) for control without significant difference (p = 0.548). TIR was 34.7% for milk, 38.7%. for yoghurt, 45.9% for kefir, and 75.5% for control during the 6-hour post snack period, with TIR on the control day significantly higher than the three snack days (p < 0.001). TBR did not differ by group (p > 0.05). Of 112 trial days, 13 days were terminated due to hyperglycemia (>300 mg/dL) (16.7 mmol/L) (8 milk, 4 yoghurt, 1 kefir), and 3 trial days due to hypoglycemia (<70 mg/dL) (3.9 mmol/L) (1 yoghurt, 2 control).

Conclusion

Bedtime snacking in young children with T1D impairs nocturnal glycemia and reduces TIR, without decreasing the frequency of hypoglycemia.

Research Insights

Kefir→Improved Time in Range
TIR was 34.7% for milk, 38.7% for yoghurt, 45.9% for kefir, and 75.5% for control during the 6-hour post snack period, with TIR on the control day significantly higher than the three snack days (p < 0.001).
Effect
Neutral
Effect size
Small
Dose
10 grams of carbohydrate
Kefir→Reduced Time Below Range
TBR did not differ by group (p > 0.05).
Effect
Neutral
Effect size
Small
Dose
10 grams of carbohydrate
Milk→Improved Time in Range
TIR was 34.7% for milk, 38.7% for yoghurt, 45.9% for kefir, and 75.5% for control during the 6-hour post snack period, with TIR on the control day significantly higher than the three snack days (p < 0.001).
Effect
Neutral
Effect size
Small
Dose
10 grams of carbohydrate
Milk→Reduced Time Below Range
TBR did not differ by group (p > 0.05).
Effect
Neutral
Effect size
Small
Dose
10 grams of carbohydrate