P-319: Optimizing post-treatment snack strategies after hypoglycemia in children and adolescents with type 1 diabetes: a randomized CGM study
C Ates, A T Canbaz, N Bekar, A Bereket, B HalilogluAbstract
Introduction
Evidence on post-treatment snacks after successful hypoglycemia treatment is limited.
Objectives
We evaluated the effects of different post-treatment snack strategies on hypoglycemia and short-term glycemic outcomes using CGM.
Methods
Children aged 8-18 years with type 1 diabetes on multiple daily injections, diabetes duration ≥1 year, and HbA1c <9% were enrolled. Nocturnal and exercise-related episodes were excluded. Hypoglycemia was defined as CGM-detected hypoglycemia confirmed by capillary glucose <70 mg/dL. Episodes were treated with 0.3 g/kg carbohydrate using a standardized fruit juice, and reassessed after 15 min. Episodes with 15-min glucose of 70–90 mg/dL were randomized to no snack, a reduced snack (8-9 g standardized complex carbohydrate), or a standard snack (15–16 g standardized complex carbohydrate); no snack was given if glucose exceeded 90 mg/dL. A total of 206 post-treatment hypoglycemic episodes from 24 participants with complete 2-hour CGM data and no food intake over 2 hours were analyzed for CGM metrics and recurrent hypoglycemia.
Results
The 15-min glucose increment was greater after level 2 than level 1 hypoglycemia (38.8±16.7 vs 31.4±12.6 mg/dL; p=0.018). Among episodes with 15-min glucose 70–90 mg/dL, the standard-snack strategy resulted in higher mean glucose, greater glycemic variability, and increased TAR-1 than the no-snack and reduced-snack strategies(Table), without reducing recurrent hypoglycemia. Outcomes were comparable between the no-snack and reduced-snack strategies. Compared with episodes reaching >90 mg/dL at 15-min without additional snack, only the standard-snack strategy was associated with greater glycemic variability and hyperglycemia(Table).
Conclusions
Post-treatment snack decisions may be guided by the 15-min glucose response. A standard snack increased hyperglycemia and glycemic variability without reducing recurrent hypoglycemia. No additional snack appeared safe when 15-min glucose exceeded 90 mg/dL.