CGM alarm use varies widely among children with diabetes
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Key takeaways:
- Most children with diabetes using CGM use low and high glucose alarms, but not low and high repeat alarms.
- Younger children are more likely to use most CGM alarms than adolescents.
CHICAGO — Children with diabetes and their caregivers use a wide variety of continuous glucose monitoring alarm settings, and usage may differ based on the child’s age, according to a presenter at ENDO 2023.
“This study informed us of widely variable alarm settings, as well as greater alarm use by children on [insulin] pumps and by children under age 12 years,” Victoria Ochs, BS, a third-year medical student at Indiana University School of Medicine, told Healio. “CGM alarms are customizable so patients can tailor their alarms to their diabetes management needs. A child with sugars ranging in the 100s mg/dL would likely have different alarms from a child with an average glucose of 300 mg/dL, because a high glucose alarm for the patient with well-controlled sugars would be overwhelming for a patient with consistently high sugars.”
Ochs and colleagues downloaded data from 150 children who were using a Dexcom G6 CGM (median age, 14 years; 47% girls; 89% white). Data were obtained from 2-week CGM reports. Clinical data and alarm settings were collected. Median alarm thresholds were compared with thresholds recommended by the PANTHER program at the Barbara Davis Center for Diabetes at the University of Colorado.
The cohort had a median HbA1c of 7.8% and a mean time in range of 47.7%. Low glucose alarm alerts were used by 87% of the cohort with a median glucose alert threshold of 74 mg/dL. The median threshold was higher than the recommended standard of 70 mg/dL (P < .0001). High glucose alarm alerts were used by 73% of participants with a median threshold of 272 mg/dL. The median high glucose alarm threshold was higher than the recommended standard of 250 mg/dL (P = .0016).
The signal lost alarm was used by 69% of children with a median time of 20 minutes until notification. The low glucose repeat alarm was used by 33% of children and the high glucose repeat alarm was used by 24%. Participants who used an insulin pump were more likely to use a high repeat alarm than those receiving insulin injections (RR = 2.2; 95% CI, 1.18-4.15; P < .01). Similarly, children using an insulin pump were more likely to use a low repeat alarm than those receiving insulin injections (RR = 1.8; 95% CI, 1.12-2.99; P = .01).
When the cohort was divided by age, children aged 12 years or younger were more likely to use the low glucose alarm (RR = 1.2; 95% CI, 1.03-1.3), the rise rate alarm (RR = 3.6; 95% CI, 1.37-9.67), the low repeat alarm (RR = 1.7; 95% CI, 1.09-2.71), the signal loss alarm (RR = 1.3; 95% CI, 1.04-1.6), the urgent low soon alarm (RR = 1.2; 95% CI, 1.07-1.41) and the urgent low soon repeat alarm (RR = 1.2; 95% CI, 1.05-1.38) than adolescents older than 12 years.
Ochs said caregivers can properly calibrate CGM alarm settings for their children by having a shared conversation with their child’s diabetes care team.
“We want to make sure patients understand their alarm needs during CGM onboarding, while also acknowledging the large volume of information patients receive with their diabetes diagnosis as well as the amount of time available for providers to spend with patients,” Ochs said.
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Ochs VS, et al. SAT-107. Presented at: ENDO annual meeting; June 15-18, 2023; Chicago.
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