Real-world data support predictive low-glucose alerts for hypoglycemia avoidance
medwireNews: The frequency at which people with type 1 diabetes experience hypoglycemia decreases during the first 30 days after they switch to a continuous glucose monitor (CGM) that incorporates a predictive low-glucose alert, research shows.
Sarah Puhr (Dexcom, Inc, San Diego, California, USA) and team analyzed data from 1424 CGM users for 30 days before and after they switched from the fifth- to the sixth-generation (G6) Dexcom real-time CGM system, the latter of which alerts users when their blood sugar is predicted to fall to 55 mg/dL or below within the next 20 minutes.
When they switched, 766 users left their predictive alert at the default glucose threshold of 80 mg/dL and 658 set theirs at the lower threshold of 70 mg/dL.
The alert was triggered less than once a day, on average. This tended to occur less often for people using the default rather than the lower threshold, at 0.6 versus 0.9 times per day, which the study authors attribute to the higher alert threshold allowing users to treat impending hypoglycemia earlier, so avoiding repeat alerts.
The note that more than 97% of users left their urgent low glucose alarm enabled, suggesting “that it was well tolerated and perceived as beneficial, rather than a nuisance.”
Switching to the G6 CGM resulted in significant reductions in the proportion of time users spent with blood glucose below 54 mg/dL, regardless of which alert threshold they used. The time in hypoglycemia fell from 0.6% to 0.4% for people with an 80 mg/dL threshold and from 1.0% to 0.6% for those with a 70 mg/dL threshold. Both reductions were statistically significant.
Notably, the reduction in hypoglycemia did not come at the expense of an increase in hyperglycemia; in fact, both groups had a significant reduction in time spent with blood glucose above 250 mg/dL, from 14.4% to 13.0% and from 12.6% to 11.1% for users with an 80 and 70 mg/dL threshold, respectively.
Puhr and colleagues describe this reduction as “unanticipated” and suggest it may be linked to the reduced hypoglycemia incidence, because this might lead to “fewer episodes of disproportionate carbohydrate intake” following a hypoglycemia episode.
They note, however, that they had no information on how patients treated impending hypoglycemia and whether they made use of high glucose alerts.
“Additional studies are needed to understand the benefit in subpopulations, such as patients with impaired awareness of hypoglycemia [or] pediatric patients,” concludes the team in Diabetes Technology & Therapeutics.
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