1926-P: Association between Continuous Glucose Monitoring Alert Settings and Glycemic Outcomes

Introduction and Objective: Real-time continuous glucose monitoring (rtCGM) offers discretionary and customizable alert features that may improve the safety and effectiveness of glucose management; however, evidence on the impact of using the available alerts in real-world practice remains scarce. We aimed to examine whether utilization of different rtCGM alerts was associated with improved glycemic management among individuals with diabetes under routine care conditions. Methods: This is a retrospective cohort study utilizing CGM data from electronic health records of a large U.S. academic health system. We included all Dexcom G6 users between 2020-2022 with sensor usage time ≥70% for each analyzed report. Results: We identified 2,387 patients for analysis. Mean (±SD) age was 42.7±21.1 years, 51.4% were women, and 71.7% were white. Low alert on was associated with lower % time below range (TBR) 54-70 mg/dL (1.65±0.05 vs. 2.09±0.14; p=.02), %TBR <54 mg/dL (0.45±0.11 vs. 0.75±0.07; p=.007), and standard deviation (SD) (55.78±0.41 vs. 57.98±0.78; p=.004), but higher % time above range (TAR) 180-250 mg/dL (26.60±0.23 vs. 24.60±0.52; p= <.001). High alert on was associated with lower average glucose (172.70±0.81 vs. 182.43±1.42; p<.001), glucose management indicator (GMI) (7.40±0.02 vs. 7.64±0.04; p<.001), SD (55.33±0.42 vs. 59.01±0.54; p<.001), %TAR >250 (13.53±0.29 vs. 17.18±0.62; p<.001), %TAR 180-250 (26.20±0.24 vs. 27.69±0.36; <.001), higher % TIR (58.14±0.44 vs. 53.30±0.71; p<.001) and higher %TBR 54-70 (1.72±0.05 vs. 1.51±0.07; p=.01), but not with %TBR <54 (0.47±0.12 vs. 0.51±0.05; p=.71). Conclusion: Enabling CGM high- or low-alert settings is associated with improved glycemia. Future applications of rtCGM should encourage activating high- and low-alert settings to optimize clinical benefit. Disclosure Y. Zheng: None. S. Johnson: None. E. Iturrate: None. B. Wu: None. H. Huang: None. W. Small: None. S. Zweig: None. R. McCoy: None. Funding New York Regional Center for Diabetes Translation Research (NY-CDTR) Pilot and Feasibility (P&F) Program Funding (P30DK111022-08).