title: Association between post-dinner dietary intakes and nocturnal hypoglycemic risk in adult patients with type 1 diabetes.
abstract: OBJECTIVE
  To describe (i) current bedtime nutritional practices and (ii) the association between post-dinner dietary intake and the occurrence of non-severe nocturnal hypoglycemia (NH) in real-life conditions among adult patients with type 1 diabetes using insulin analogs.
  
  
  METHODS
  One hundred adults (median [interquartile range]: age 46.4 [36.0-55.8] years, HbA1c 7.9 [7.3-8.6] % (63 [56-70] mmol/mol)) using multiple daily injections (n=67) or insulin pump (n=33) wore a blinded continuous glucose monitoring system and completed a food diary for 72-h.
  
  
  RESULTS
  NH occurred on 28% of 282 nights analyzed. (i) Patients reported post-dinner dietary intakes on 63% of the evenings. They injected rapid-acting insulin boluses on 64 occasions (23% of 282 evenings). These insulin boluses were mostly injected with (n=37) dietary intakes. (ii) Post-dinner dietary intake was not associated with NH occurrence in univariate analyses. In multivariate analyses, the injection of rapid-acting insulin modulated the association between post-dinner dietary intake and NH: with insulin, post-dinner carbohydrate intake was positively associated with NH (odds ratio (OR): 1.16 [95% confidence interval, CI: 1.04-1.29] per 5g increase, p=0.008); without insulin, post-dinner protein intake was inversely associated with NH occurrence (OR [95% CI]: 0.88 [0.78-1.00] per 2g increase, p=0.048).
  
  
  CONCLUSIONS
  NH remains frequent in adults with type 1 diabetes. There is a complex relationship between post-dinner dietary intake and NH occurrence, including the significant role of nutrient content and rapid-acting insulin injection that requires further investigation.
authors.affiliation: Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada; Department of nutrition, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Desjardins
authors.affiliation: Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Brazeau
authors.affiliation: Department of nutrition, Université de Montréal, Montreal, Quebec, Canada; Université de Montréal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada; Montreal Diabetes Research Center (MDRC), Montreal, Quebec, Canada.
authors.forename: Irene
authors.initials: I
authors.lastname: Strychar
authors.affiliation: Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada; Department of nutrition, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Leroux
authors.affiliation: Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada; Department of nutrition, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Véronique
authors.initials: V
authors.lastname: Gingras
authors.affiliation: Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada; Department of nutrition, Université de Montréal, Montreal, Quebec, Canada; Montreal Diabetes Research Center (MDRC), Montreal, Quebec, Canada; Division of Endocrinology, Department of Medicine of the Université de Montréal Hospital Center (CHUM), Montreal, Quebec, Canada. Electronic address: Remi.rabasa-lhoret@ircm.qc.ca.
authors.forename: Rémi
authors.initials: R
authors.lastname: Rabasa-Lhoret
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000178:diet therapy / Q000188:drug therapy*; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000097:blood; D007336:Insulin, Isophane / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D019518:Postprandial Period; D011792:Quebec / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D007336:Insulin, Isophane
keywords: Carbohydrate; Continuous glucose monitoring; Dietary protein; Nocturnal hypoglycemia; Nutrition; Type 1 diabetes