Integrating continuous glucose monitoring alarms in primary care: Evaluation of utilization rates and achieved glycemic control in people with type 2 diabetes treated with insulin.

Abstract

This study aims to evaluate the impact of alarm activation on Continuous Glucose Monitoring (CGM) metrics in people with type 2 diabetes (PwT2D) using the FSL2 system in a primary care setting. A cross-sectional study was conducted including PwT2D who were treated with insulin, used FreeStyle Libre 2 system and were managed at the Cafam FreeStyle Libre (FSL) Program, in Bogotá, Colombia. All patients received education upon enrolment and were followed up by a team of primary care physicians (PCP). Data were obtained from the LibreView and LibreLens platforms. CGM metrics based on alarm usage were analyzed. Additionally, glycemic control and adherence metrics were evaluated classifying patients into three groups: adequate control (TBR>70%,TBR<4%), high-risk of hypoglycemia (TBR≥4%), or high-risk of hyperglycemia (TIR≤70%,TBR<4% and TAR>25%). Analysis of 221 individuals (median age 61; IQR 51-71) revealed that only 14.5% had active glucose alarms. Those with active alarms showed a non-significant trend toward improved glycemic control (median TIR 65% [52.8-79.3%] vs 61% [42.5-75%], p = 0.107). Glycemic risk stratification showed that 53% of participants were at high risk for hyperglycemia and 19% at high risk for hypoglycemia, with only 28% achieving adequate control. No CGM adherence differences were found between groups. Patients with active alarms tend to have a higher TIR, suggesting that alarm activation may positively influence glycemic control in this population. However, given the low rate of alarm utilization, structured training to promote alarm use among PwT2D under PCPs follow-up is essential.