Bedtime snacking may worsen T1D control in kids

In young children with type 1 diabetes (T1D), bedtime snacking appears to result in higher nocturnal glucose values and reduced time in range (TIR), without decreasing the frequency of hypoglycaemia, according to a randomized controlled crossover trial.

The study included 28 paediatric T1D patients (mean age 6.6 years, 13 female) with mean HbA1c of 7 percent who were using multiple daily injection therapy. These children were assigned to receive 10 grams of milk, yoghurt, and kefir in a randomized order. Each snack was given 150–180 min after dinner over 3 nights.

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 range, time below 70 mg/dL, and other metrics were analysed based on international CGM consensus. Blood glucose levels exceeding 300 mg/dL or falling below 70 mg/dL resulted in trial day termination.

There were no significant differences observed in mean glucose values before the test snacks of 137.8 mg/dL for milk, 141.9 mg/dL for yoghurt, 136 mg/dL for kefir, and 140.8 mg/dL for control (p=0.548).

Time in range was 34.7 percent for milk, 38.7 percent for yoghurt, 45.9 percent for kefir, and 75.5 percent for control during the 6-h period after the snack. Time in range on the control day was significantly higher than the time in range on 3 snack nights (p<0.001). There was no significant difference seen in time below range.

Finally, of 112 trial days, 13 were terminated due to hyperglycaemia (>300 mg/dL) (8 milk, 4 yoghurt, 1 kefir), while 3 trial days were terminated due to hypoglycaemia (<70 mg/dL).