Implementing Continuous Glucose Monitoring Alerts in Clinical Settings—Moving Beyond Efficacy

To assess the individual contributions of threshold and predictive continuous glucose monitoring (CGM) alarms in hospitalized adults with diabetes.

Study Design: A three-arm randomized clinical trial involving 533 adults in a specialized endocrinology unit.
Intervention: Participants received either CGM alone, CGM with threshold alarms, or CGM with both threshold and predictive alarms.

Threshold alarms improved time in range (TIR) by 3.9 percentage points compared to CGM alone, but the study environment was resource-rich and may not reflect standard inpatient care.
Predictive alarms did not yield any glycemic advantage.

The effectiveness of CGM alarms is influenced by clinical frameworks and implementation strategies.

The study was conducted in a specialized unit, limiting generalizability.
Lack of clarity on the operationalization of predictive alerts and their clinical response.

Future research should prioritize transparent documentation of alarm implementation and fidelity to enhance understanding of CGM alarm systems.