CHICAGO — Kids who use continuous glucose monitors (CGMs) to manage their diabetes often don’t have settings to alert them and their caregivers to sugar levels that are out of range, pointing to a potential gap in education and onboarding, real-world data showed.
In a study of 150 children and adolescents using CGMs with type 1 or type 2 diabetes, 27% of the devices never set a high glucose alert, while 13% never set low threshold alerts and 31% had none. an indication of when a signal was lost, according to Victoria Ochs, a third-year medical student at the Indiana University School of Medicine in Indianapolis.
More importantly, some never changed the default setting that comes from the manufacturer, which can lead to alarms that are inappropriate for the patient and cause them to completely ignore the signals, she said at a news conference at ENDO 2023, the Endocrine Society’s annual meeting.
Ochs gave the example of a patient who sets a high-alarm signal at 150 mg/dL when his blood sugar is consistently running at 200 mg/dL. “They will be alerted all the time,” she said MedPage Today, and the patient will eventually tune them out. “It’s called ‘alert fatigue.’ That’s why it’s really important to maximize the information they get.”
The study found that it was more common for patients and parents to set fewer alarms than recommended, and even when users did set alarms, they were often significantly different from those recommended.
“Overall, the high variability of alarm settings indicates a likely educational shortcoming in on-board and in-use continuous glucose monitoring,” Ochs said. “This study shows that there is both an opportunity for diabetes healthcare teams to identify best practices for alert use during onboarding and to continue messaging and working with patients and families to maximize use on an ongoing basis.”
The CGM automatically measures glucose levels throughout the day and night, allowing patients to see their glucose levels at a glance at any time and view how glucose changes over hours or days to see trends. Monitoring glucose levels in real time can help make more informed decisions throughout the day about how to balance food, exercise and medications, including insulin, Ochs suggested.
However, there are few data on how real-time CGM alerts are used in children, she said.
To evaluate this, the researchers looked at data on 150 children who used the Dexcom G6 CGM. Patients had a median age of 14 years, a median hemoglobin A1c of 7.8%, and a median duration of 47%. The researchers reviewed biweekly CGM reports from each participant, which included alarm settings.
A low glucose alert was set by 131 of the patients, a high glucose alert was set by 109, and a signal loss alert was set by 103 patients.
Thresholds for alerts often differed from the recommended glucose limits (250 mg/dL for high and 70 mg/dL for low), Ochs said. For the higher limits, patients set alerts between 120 and 400 mg/dL, while user settings ranged from 60 to 100 mg/dL for low glucose alerts. And variability was seen among recurring high glucose alerts (where 2 hours is recommended), with participants having recurring alerts set anywhere from 15 minutes to 3 hours.
The researchers found that patients on insulin pumps were more likely to use certain warning signs than injection patients, and found that younger study participants, especially children 12 and younger, were more likely to use the majority of available warnings than older participants.
Commenting on the study’s findings, Maria Stamou, MD, PhD, of Mass General Brigham/Harvard Medical School in Boston, said, MedPage Today that “physicians have been and should continue to spend time with their patients and caregivers to review data and settings for continuous glucose monitoring and determine what causes blood sugar to rise and fall during the day and night.”
“Addressing alert fatigue in our patients and assessing each patient’s needs by focusing on diabetes and continuous glucose monitoring/pump education is very important,” added Stamou, who was not involved in the study.
Ochs had no information. One researcher is an employee of Lilly; other disclosed consultant or advisory board relationships with Merck, Vertex and Abata.
Stamou disclosed no relevant industry affiliations
Reference: Ochs VS, et al. “Assessing continuous glucose monitor alarm use by families of children with diabetes” ENDO 2023.
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