Improved Real-World Glycemic Control With Continuous Glucose Monitoring System Predictive Alerts

Sinu Bessy Abraham, Siddharth Arunachalam, Alex Zhong, Pratik Agrawal, Ohad Cohen, Chantal M. McMahon*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Most standalone real-time continuous glucose monitoring (RT-CGM) systems provide predictive low and high sensor glucose (SG) threshold alerts. The durations and risk of low and high SG excursions following Guardian™ Connect CGM system predictive threshold alerts were evaluated. Methods: Continuous glucose monitoring system data uploaded between January 2, 2017 and May 22, 2018 by 3133 individuals using multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII) therapy were deidentified and retrospectively analyzed. Glucose excursions were defined as SG values that went beyond a preset low or high SG threshold for ≥15 minutes. For a control group, thresholds were based on the median of the low SG threshold limit (70 mg/dL) and the high SG threshold limit (210 mg/dL) preset by all system users. During periods when alerts were not enabled, timestamps were identified when a predictive alert would have been triggered. The time before low horizon was 17.5 minutes and the time before high horizon was 15 minutes, of all users who enabled alerts. Excursions occurring after a low SG or high SG predictive alert were segmented into prevented, ≤20, 20-60, and >60 minutes. Results: Excursions were prevented after 59% and 39% of low and high SG predictive alerts, respectively. The risk of a low or high excursion occurring was 1.9 (P < 0.001, 95% CI, 1.88-1.93) and 3.3 (P < 0.001, 95% CI, 3.20-3.30) times greater, respectively, when alerts were not enabled. Conclusions: The predictive alerts of the RT-CGM system under study can help individuals living with diabetes prevent some real-world low and high SG excursions. This can be especially important for those unable to reach or maintain glycemic control with basic RT-CGM or CSII therapy.

Original languageEnglish
Pages (from-to)91-97
Number of pages7
JournalJournal of diabetes science and technology
Issue number1
StatePublished - 2019
Externally publishedYes


FundersFunder number


    • continuous glucose monitoring
    • hyperglycemia
    • hypoglycemia
    • predictive threshold alerts
    • type 1 diabetes
    • type 2 diabetes


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