Wide Variation in CGM Settings for Kids With Diabetes Signals Education Gaps

— Researcher warns of “apprehension fatigue” if thresholds are no longer optimized to affected person

by
Ed Susman, Contributing Author, MedPage Nowadays
June 20, 2023

CHICAGO — Kids the use of precise glucose shows (CGMs) to manipulate their diabetes customarily attain no longer luxuriate in settings in place to alert them and their caregivers about out-of-vary sugar levels, suggesting likely gaps in education and onboarding, staunch-world data showed.

In a discover that integrated 150 teenagers and teenagers the use of CGMs for their form 1 or form 2 diabetes, a excessive glucose apprehension used to be never space on 27% of the units whereas 13% never space up signals for when the decrease limit had been reached and 31% had no indication when a loss of signal befell, basically based totally on Victoria Ochs, a Third-year medical scholar at Indiana College College of Medication in Indianapolis.

More importantly, some never changed the default atmosphere that comes from the producer, that may presumably result in alarms sounding which shall be inappropriate for the affected person and result in them ignoring the indicators entirely, she acknowledged at a press convention at ENDO 2023, the annual meeting of the Endocrine Society.

Ochs gave the instance of a affected person who units their excessive apprehension at 150 mg/dL when their blood sugars are repeatedly running at 200 mg/dL. “They’ll procure signals all of the time,” she told MedPage Nowadays, and the affected person will finally tune them out. “It be known as ‘apprehension fatigue.’ For this reason it be in actuality vital to optimize the straightforward project they’re getting.”

The discover found it used to be extra frequent for sufferers and folks to space fewer alarms than urged, and even when customers did space signals, they had been customarily very much varied cutoffs from those urged.

“Total, the broad variability of noticed apprehension settings signifies doubtless academic gaps in precise glucose monitoring onboarding and use,” Ochs acknowledged. “This discover reveals that there may be every the alternative for the diabetes healthcare team to present apprehension-use simplest-practices during onboarding and to proceed to message and work with sufferers and families to optimize use on an ongoing basis.”

CGMs robotically discover glucose levels during the day and evening, allowing sufferers to peep their glucose levels at a discover at any time and overview how glucose changes over a pair of hours or days to peep traits. Staring at glucose levels in staunch time can abet with making extra told choices during the day about how to balance meals, physical issue, and medicines, together with insulin, Ochs urged.

Nevertheless, few data exist on how staunch-time CGM alarms are aged in the pediatric inhabitants, she acknowledged.

To evaluate this, the researchers scrutinized data on 150 teenagers the use of the Dexcom G6 CGM. Patients had a median age of 14 years extinct, a median hemoglobin A1c of seven.8%, and mean time-in-vary of 47%. The researchers reviewed 2 weeks’ worth of CGM experiences from every participant, which integrated apprehension settings.

Low glucose alarms had been space by 131 of the sufferers, excessive glucose alarms had been space by 109, and loss of signal alarms had been space by 103 of the sufferers.

Thresholds for signals customarily differed from the urged glucose limits (250 mg/dL for excessive and 70 mg/dL for decrease limit), Ochs acknowledged. For the increased limits, sufferers space alarms ranging from 120 to 400 mg/dL, whereas customers’ settings ranged from 60 to 100 mg/dL for the low glucose stage signals. And variation used to be seen among repeat signals for a excessive glucose stage (the place 2 hours is urged), with people having repeat signals space anyplace from quarter-hour to three hours.

The researchers found that sufferers on insulin pumps had been extra liable to use particular alarms bigger than injection sufferers, and found that younger discover people, specifically teenagers 12 and below, had been extra liable to use a majority of the on hand alarms than older people.

In commenting on the discover findings, Maria Stamou, MD, PhD, of Mass Overall Brigham/Harvard Medical College in Boston, told MedPage Nowadays that “clinicians had been and may presumably proceed to use time with their sufferers and caregivers to search out out about their precise glucose monitoring data and settings and settle on what causes blood sugars to switch up and down during the day and evening.”

“It’s terribly vital to address apprehension fatigue with our sufferers and assess every affected person’s wants in my view by specializing in diabetes and precise glucose monitoring/pump education,” added Stamou, who used to be no longer obsessed on the discover.