Low-fat vs. high-fat bedtime snacks in children and adolescents with type 1 diabetes.
OBJECTIVE
The purpose of this study was to determine whether, in a group of children with type 1 diabetes using insulin pump, a prebedtime snack with a relatively high fat content provides greater protection from nocturnal hypoglycemia than a snack containing the same amount of carbohydrate and protein but a lower fat content.


METHODS
Ten subjects, aged 6 to <18 yr, in a trial evaluating the Abbott Navigator glucose sensor, agreed to this ancillary study. On 12 or more separate nights, each subject was randomized by a Web site to a carbohydrate-low-fat (30 g CHO, 2.5 g protein, and 1.3 g fat; 138 kcal) snack or a carbohydrate-high-fat (30 g CHO, 2 g protein, and 20 g fat; 320 kcal) snack. Subjects used their usual evening snack algorithm to determine the size (in 15-g carbohydrate increments) and insulin dosage.


RESULTS
Average glucose on 128 valid study nights before snack was similar in both groups. The proportion of nights with hypoglycemia (a sensor or meter glucose value <or=70 mg/dL) was similar in both groups (19% high fat vs. 20% low fat), as was the proportion of nights with hyperglycemia (a glucose >or=200 mg/dL and at least 50 mg/dL above baseline, 35% high fat vs. 30% low fat).


CONCLUSIONS
There were no statistical differences between the high- and low-fat snacks on the frequency of hyperglycemia or hypoglycemia. This study highlights the feasibility of web-based research in patients' home environment.
Wilson
Darrell
D
Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, CA, USA. direcnet@jaeb.org
Chase
H Peter
HP
Kollman
Craig
C
Xing
Dongyuan
D
Caswell
Kimberly
K
Tansey
Michael
M
Fox
Larry
L
Weinzimer
Stuart
S
Beck
Roy
R
Ruedy
Katrina
K
Tamborlane
William
W