Use of High-Glucose Alerts is Associated With Better Glycemic Control in Individuals Using Real-Time Continuous Glucose Monitoring

The clinical efficacy of real-time continuous glucose monitoring (RT-CGM) is well established.The Dexcom G6 RT-CGM mobile app allows access to several features, including a "High Glucose" threshold alert (programmable between 120 and 400 mg/dL).The presence of alerts as in RT-CGM systems is associated with improved glycemic outcomes compared to intermittently scanned CGM (IS-CGM) systems which lack alerts. 1 Lower glucose thresholds for hyperglycemia alerts have been associated with improved glycemic outcomes. 2However, some users experience alarm fatigue. 3In this analysis of real-world data, we explored the impact of permanently disabling this alert in a large cohort of Dexcom G6 users.A random subsample of 500 000 U.S.-based users was obtained with a first glucose upload date between July 1, 2020 and June 30, 2022.In this subsample, 46 159 users (11.5%) disabled the high-glucose alert.Next, we identified 3674 users who disabled the high-glucose alert after having it initially enabled (DHG) and 3674 case-matched users who never disabled the high-glucose alert (NDHG).Rigorous case-matching was employed with respect to the time between the first most recent upload dates.The index date was defined as the date that the DHG user disabled their high-glucose alert.Glycemic control and number of initial high-glucose alerts were compared between the DHG and NDHG groups.The DHG group experienced a clear deterioration in percent time in range (%TIR) in the days leading up to the index date and a striking decrease in %TIR on the index date before recovering to a new, slightly lower steady state (Figure 1a).Average percent time above range (%TAR) and mean glucose followed a similar, but inverted, pattern (Figure 1b andc).Interestingly, aside from a few days before the index date,