Systematic literature review: should a bedtime snack be used to treat hyperglycemia in type 2 diabetes?

Lauren A Roach; William Woolfe; Beenu Bastian; Elizabeth P Neale; Monique E Francois

doi:10.1093/ajcn/nqac245

Systematic literature review: should a bedtime snack be used to treat hyperglycemia in type 2 diabetes?

Am J Clin Nutr. 2022 Nov;116(5):1251-1264. doi: 10.1093/ajcn/nqac245. Epub 2023 Feb 10.

Authors

Lauren A Roach¹, William Woolfe², Beenu Bastian³, Elizabeth P Neale⁴, Monique E Francois⁴

Affiliations

¹ School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia. Electronic address: lroach@uow.edu.au.
² School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, New South Wales, Australia.
³ School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Shoalhaven Local Health District, Diabetes Service, Wollongong, New South Wales, Australia.
⁴ School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.

Abstract

Background: Consuming a bedtime snack is often recommended for people with type 2 diabetes.

Objective: This systematic review aims to evaluate the evidence from intervention studies to determine whether consuming a bedtime snack improves fasting hyperglycemia and/or overall glycemic control in individuals with type 2 diabetes.

Methods: PubMed, Medline (EBSCO), Cochrane Library, and CINAHL Plus (EBSCO) databases were searched until 20 July, 2022. We included prospective studies in people with type 2 diabetes or prediabetes that included the intervention of a bedtime snack, consumed >30 min after dinner and <2 h before bed and reported glycemic outcomes.

Results: The systematic review included 16 studies. There was no consistent relationship between consumption of a bedtime snack and improved glycemic control, especially when a no-snack control was included. Of the 4 studies that included the use of corn starch, a low dose seemed to have benefits over high-dose corn starch in terms of improved nocturnal and fasting glucose concentrations.

Conclusions: Current advice to consume a bedtime snack is based on a limited number of intervention studies that often do not include a no-snack control, nor have used a feasible bedtime snack option that could be translated into everyday clinical practice. Further research is needed in type 2 diabetes patients treated with or without insulin. This review was registered at the Prospective Register of Systematic Reviews (PROSPERO) as CRD42020182523.

Keywords: bedtime snack; fasting hyperglycemia; glycemic control; systematic review; type 2 diabetes.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Blood Glucose
Diabetes Mellitus, Type 1*
Diabetes Mellitus, Type 2* / drug therapy
Humans
Hyperglycemia* / drug therapy
Hyperglycemia* / prevention & control
Hypoglycemia*
Insulin
Prospective Studies
Starch
Systematic Reviews as Topic

Substances

Blood Glucose
Insulin
Starch