Çoklu Doz İnsülin Tedavisi Alan Tip 1 Diyabetli Çocuklarda Gece Ara Öğün Seçeneklerinin Nokturnal Glisemiye Etkilerinin İncelenmesi

Abstract

Gökçe, T. Assessment of the impact of bedtime snack choices on nocturnal glycemia in young children with type 1 diabetes undergoing multiple dose insulin injection therapy. Hacettepe University Graduate School of Health Sciences Master of Science Thesis in Dietetics, Ankara, 2022. This study was designed as a trial with regards to assessment of glucose values after 4 different snack choices in 4 different trial day, and conducted on 28 participants aged between 5-7 with Type 1 diabetes using multiple daily injection theraphy (MDI) in order to determine if young children require a bedtime snack to maintain overnight glycemia, also assess of the impact of different bedtime snack options. Substitutions of 10 g carbohydrate of milk, yoghurt and kefir compared to no snack option. Continuous glucose monitoring (isCGM) was used to measure 6-hour glucose levels after snacks, a total of 112 patient-days were analyzed. If capillary glucose value reaches 300 mg/dL or falls below 70 mg/dL, the trial day was ceased. The data up to this point were analyzed for the early (0 to 2 hours), late (2 to 6 hours) and total (0-6 hours) postprandial period with Repeated Measures Anova. While glycemic parameters were evaluated as Time in Range (TIR), Time Above Range for level 1 and level 2 (TAR1-TAR2) and Time Below Range for level 1 and level 2 (TBR1-TBR2) according to the International CGM Consensus Report, the incremental area under the curve (iAUC) of 6 hours following the snacks as well as glucose levels were compared. Glycemic response was significantly higher in milk, yoghurt and kefir in comparison to the no snack option, both in the early (0-2 h iAUC), late (2-6 h iAUC) and total (0-6 h iAUC) period (p<0,001). There was not a statistically significant difference in glycemic response after milk, yoghurt and kefir options. The 0-6 hour mean TIR were 34,7 %, 38,7 %, 45,9 % and 75,5 % milk, yoghurt, kefir and no snack groups respectively and the TIR of the no snack condition was higher than snack options (p<0.001). In the late postprandial period, TAR2 was higher in the milk group than in the no snack and yogurt groups, while TAR1 was similar among the snack options. In the milk, yoghurt, kefir and no snacks conditions, the percentages of children who were ceased early due to high values were 7 %, 4 %, 1 % and 0 %; due to low values were 0 %, 1 %, 0 % and 2 %, respectively. In terms of time in range centered diabetes care, our results suggest no bedtime snack is the good option. But in terms of preventing the hypoglycemia, sensor glucose cut-off values need to be determined for the bedtime snack recommendation.