{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T10:09:53Z","timestamp":1788775793624,"version":"build-2803163510"},"reference-count":19,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Bedtime snacks are frequently used in youth with type 1 diabetes (T1D) to reduce nocturnal hypoglycemia risk; however, the optimal macronutrient composition remains uncertain, particularly in those treated with multiple daily injections (MDI). This randomized crossover study evaluated whether standardized whole-food bedtime snacks with different macronutrient profiles yield distinct overnight continuous glucose monitoring (CGM) patterns. Methods: Twelve children and adolescents with T1D using glargine\/lispro-based MDI completed four bedtime snack protocols: carbohydrate-only (CHO), carbohydrate-plus-protein (CHO + PRO), carbohydrate-plus-fat (CHO + FAT), and carbohydrate-plus-fiber (CHO + FIB). Each snack was consumed for three consecutive nights at 21:00 without additional bolus insulin. Blinded CGM data were analyzed for 21:00\u201309:00 and for predefined postprandial intervals. Because no a priori sample size calculation was performed, the study was conducted as an exploratory pilot trial. Nights per snack were averaged before within-subject comparisons. Results: Overnight time in range (TIR; 70\u2013180 mg\/dL) varied across protocols (p = 0.014), with the highest TIR following CHO + PRO (85.8% \u00b1 12.1%) and the lowest following CHO + FAT (70.9% \u00b1 19.1%); however, adjusted whole-night pairwise comparisons were not statistically significant. Differences were more pronounced during the first 6 h following snack consumption, when CHO + PRO was associated with higher TIR than CHO + FAT (91.2% \u00b1 7.6% vs. 71.4% \u00b1 20.8%; adjusted p = 0.011). Moreover, CHO + PRO was associated with lower peak-to-nadir glucose amplitude than CHO + FAT (88.1 \u00b1 24.9 vs. 123.9 \u00b1 36.5 mg\/dL; adjusted p = 0.041). Hypoglycemic and hyperglycemic event rates did not significantly differ across protocols. Conclusions: In children and adolescents with T1D using MDI, bedtime snack composition was associated with differences in early nocturnal glycemic stability. CHO + PRO demonstrated higher early night TIR and lower glucose amplitude than CHO + FAT; however, event-based safety outcomes did not significantly differ. Because only two pairwise comparisons remained significant after correction for multiple testing and the four snacks were not matched for energy content, these findings should be regarded as preliminary and hypothesis-generating; in particular, they do not demonstrate that any snack composition protects against nocturnal hypoglycemia. Confirmation is required in larger, adequately powered studies that include energy-matched snacks and a no-snack control condition.<\/jats:p>","DOI":"10.3390\/nu18172924","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T09:23:37Z","timestamp":1788773017000},"page":"2924","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bedtime\u00a0Snack\u00a0Composition\u00a0and Overnight Glycemic Profiles in Children and Adolescents with Type 1 Diabetes Using Multiple Daily Injections: A Randomized Crossover Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0791-916X","authenticated-orcid":false,"given":"Didem","family":"G\u00fcne\u015f Kaya","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Cerrahpa\u015fa Faculty of Medicine, Istanbul University-Cerrahpa\u015fa, Istanbul 34098, T\u00fcrkiye"},{"name":"Department of Nutrition and Dietetics, Graduate School of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul 34638, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6732-8823","authenticated-orcid":false,"given":"Elvan","family":"Bayramo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Endocrinology, Cerrahpa\u015fa Faculty of Medicine, Istanbul University-Cerrahpa\u015fa, Istanbul 34098, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0121-3756","authenticated-orcid":false,"given":"Hande","family":"Turan","sequence":"additional","affiliation":[{"name":"Department of Pediatric Endocrinology, Cerrahpa\u015fa Faculty of Medicine, Istanbul University-Cerrahpa\u015fa, Istanbul 34098, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4851-8637","authenticated-orcid":false,"given":"Olcay","family":"Evliyao\u011flu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Endocrinology, Cerrahpa\u015fa Faculty of Medicine, Istanbul University-Cerrahpa\u015fa, Istanbul 34098, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0494-301X","authenticated-orcid":false,"given":"Murat","family":"Bas","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Graduate School of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul 34638, T\u00fcrkiye"},{"name":"Department of Nutrition and Dietetics, Faculty of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul 34638, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"ref_1","first-page":"546","article-title":"International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2024: Glycemic Targets","volume":"97","author":"Agwu","year":"2025","journal-title":"Horm. 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