Real-time continuous glucose monitoring (CGM) systems with threshold alerts can disencumber users by automatically warning of out-of-range glucose values. We examined correlations between time in ...range (TIR; 70-180 mg/dL), hyperglycemia alert use, and screen view frequency in a large real-world cohort. Anonymized data uploaded in 2020 by 19,367 US-based users of the G6 CGM System (Dexcom, Inc., San Diego, CA) were assessed. Data from users with >70% device utilization and validated alert settings were included. Users were stratified by screen view frequency and hyperglycemia alert use. Panel A shows TIR vs. screen view frequency for 3 cohorts defined as having the hyperglycemia alert always, sometimes, or never on. Compared to non-use, consistent use of the hyperglycemia alert corresponded to a ~5.5% higher TIR. By contrast, screen view frequency was weakly associated with increased TIR, likely because the trend screen must be accessed to silence the alert. Panel B shows the moderate inverse correlation between TIR and hyperglycemia alert setting. Automated hyperglycemia alerts may motivate appropriate treatment decisions without requiring constant scrutiny of the CGM trend screen. Lowering the hyperglycemia alert threshold may be an appropriate strategy for patients wishing to improve their TIR.
Accuracy and feature sets of continuous glucose monitoring (CGM) systems may influence device utilization and outcomes. We compared clinical trial accuracy and real-world utilization and ...effectiveness of two different CGM systems.
Separately conducted accuracy studies of a fifth-generation and a sixth-generation CGM system involved 50 and 159 adults, respectively. For between-system performance comparisons, propensity score methods were utilized to balance cohort characteristics. Real-world outcomes were assessed in 10,000 anonymized patients who had switched from the fifth-generation to the sixth-generation system and had used connected mobile devices to upload data from both systems, allowing pairwise comparisons of device utilization and glucose concentration distributions.
Propensity score-adjusted mean absolute relative differences for the fifth- and sixth-generation systems were 9.0% and 9.9%, and the percentages of values within ±20%/20 mg/dL were 93.1% and 92.5%, respectively. The sixth-generation system, but not the fifth-generation system, met accuracy criteria for interoperable CGM systems. Both systems had high real-world utilization rates (93.8% and 95.3% in the fifth- and sixth-generation systems, respectively). Use of the sixth-generation system was associated with fewer glucose values <55 mg/dL (<3.1 mmol/L) (0.7% vs. 1.1%, P < 0.001) and more values 70-180 mg/dL (3.9-10.0 mmol/L) (57.3% vs. 56.0%, P < 0.001) than the fifth-generation system.
CGM performance outcomes can be compared through the propensity score analysis of clinical trial data and pairwise comparisons of real-world data. The systems compared here had nearly equivalent accuracy and utilization rates. Longer term biochemical and psychosocial benefits observed with the fifth-generation system are also expected with the sixth-generation system.
Programmable and fixed auditory and/or vibratory threshold alerts are essential features of real-time continuous glucose monitoring (rtCGM) systems that provide users time to intervene before the ...onset of clinical hypoglycemia or hyperglycemia. A sixth-generation rtCGM system from Dexcom, Inc. (G6) includes a new alert that is triggered when an algorithm predicts that an estimated glucose value ≤55 mg/dL will occur within 20 min, allowing users more time to act to avoid hypoglycemia. We examined whether this predictive low glucose alert provided added benefit to traditional low threshold alerts.
We analyzed glucose values from an anonymized sample of 1424 patients who transitioned to G6 from the preceding fifth-generation system (G5) with no predictive alert. Users with the low threshold alert setting of 70 or 80 mg/dL were evaluated separately. Receiver users, those who disabled the predictive low glucose alert, or those with <30 days of data immediately before or after the transition to G6 were excluded.
Percent time <54, ≤55, <70, and >250 mg/dL fell significantly after the transition to G6, independent of low threshold alert setting. Time in range improved for G6 users with a low threshold alert setting of 70 mg/dL.
Advance warning provided by predictive low glucose alerts may further reduce hypoglycemia among rtCGM-experienced users.
CGM data can be summarized and reviewed retrospectively. CLARITY provides options for reviewing data from Dexcom CGM systems, including on-demand reports and five types of notifications (disabled by ...default) that are auto-generated and pushed to users’ smart devices. We examined user engagement with CLARITY reports and notifications, and their associations with estimated glucose value (EGV)-based parameters. EGVs uploaded in October 2019 from a convenience sample of 2,637 U.S.-based users of Dexcom CGM systems were analyzed. Group 1 did not access CLARITY, Group 2 accessed on-demand reports but not auto-generated notifications, and Group 3 enabled all types of auto-generated notifications throughout that month. For each group, EGV-based parameters including time in range (TIR) and the % of users meeting consensus-based goals were calculated. Unpaired t-tests were used to compare time in ranges; two-proportion z-tests were used to compare % of users meeting goals. Auto-generated CLARITY notifications were associated with more TIR and less time spent in hyperglycemia, with clinically and statistically significant differences in favor of Group 3 vs. Group 1. A significantly higher proportion of users in Group 3 than in Group 1 met consensus goals for TIR (Table). Push notifications related to CGM data may contribute to patient engagement and/or to beneficial therapeutic choices.
Disclosure
K. Shankar: Employee; Self; Dexcom, Inc. P. Hastedt: None. M. Derdzinski: Employee; Self; Dexcom, Inc. J. Welsh: Employee; Self; CSL Behring. C. Barger: Employee; Self; Dexcom, Inc. G. Cohen: Employee; Self; Dexcom, Inc.
Background: Children and adolescents with diabetes may use data from continuous glucose monitoring (CGM) in management decisions and may share it in real time with others involved in their care. CGM ...systems from Dexcom (San Diego, CA) allow real-time sharing with up to 5 remote “Followers.” We explored associations between the presence of Follower(s), device utilization, and glycemic parameters.
Methods: We used estimated glucose values (EGVs) from a convenience sample of 25,000 CGM users of Dexcom's G5 or G6 system ages 2-24 that were uploaded between 5/1/2018 and 9/30/2018 by an app that allows for sharing. The number of Follower(s) was established on 8/10/2018. Each day with ≥1 valid EGV was counted as a day of device usage. Comparisons were made with two-sided Welch’s t-tests.
Results: Overall, 90.0% of the population used the sharing feature and had ≥1 Follower; the mean numbers of Followers for patients ages <8, 8-14, and 15-24 years were 2.73, 2.69, and 1.83, respectively. In all 3 age groups, having a Follower was associated with lower mean EGVs, more EGVs in the 70-180 mg/dL range, fewer EGVs in hypo- or hyperglycemia, and more device utilization (Table).
Conclusions: Real-time sharing and following of CGM data may encourage consistent device usage and facilitate timely interventions by parents of young children with diabetes or improve self-care behaviors among adolescents and young adults with diabetes.
Disclosure
A. Parker: Employee; Self; Dexcom, Inc. M. Derdzinski: Employee; Self; Dexcom, Inc. S. Puhr: None. J. Welsh: Employee; Self; Dexcom, Inc. T.C. Walker: Employee; Self; Dexcom, Inc. A. Jimenez: Employee; Self; Dexcom, Inc.
Background: The Dexcom G6 continuous glucose monitoring (CGM) system differs from Dexcom’s earlier G5 system in that G6 includes a predictive “Urgent Low Soon” (ULS) alert that notifies users when an ...estimated glucose value (EGV) ≤55 mg/dL is predicted in the next 20 minutes. The effect of the ULS alert on the distribution of EGVs was evaluated in the context of traditional threshold alerts.
Methods: We identified individuals who had used G5 and transitioned to G6 between 5/1/2018 and 10/31/2018. Evaluable data were from a subset of 4083 users who had maintained low threshold alerts at either 70 or 80 mg/dL, who used a smartphone to view and upload ≥30 days of data from each system, and who maintained the G6 ULS alert in its default (enabled) state.
Results: Use of the 80 mg/dL low threshold alert was associated with higher mean EGVs, less hypoglycemia, and more hyperglycemia than use of the 70 mg/dL low threshold alert (Table). Over 97% of the G6 systems were used with the ULS feature enabled, and the ULS alert was activated less than once daily. At either low threshold setting, the transition to G6 was associated with reductions in hypoglycemia (<55 and <70 mg/dL) and severe hyperglycemia (>250 mg/dL).
Conclusions: When used in the context of traditional low threshold alerts, the predictive ULS alert may enable timely and appropriate interventions that contribute to further reductions in hypoglycemia among CGM-experienced users.
Disclosure
M. Derdzinski: Employee; Self; Dexcom, Inc. J. Welsh: Employee; Self; Dexcom, Inc. S. Puhr: None. T.C. Walker: Employee; Self; Dexcom, Inc. A. Parker: Employee; Self; Dexcom, Inc. A. Jimenez: Employee; Self; Dexcom, Inc.
Background
Those caring for children and adolescents with diabetes often use glucose concentration and trending information in management decisions. Some continuous glucose monitoring (CGM) systems ...offer real-time sharing and monitoring capabilities through mobile apps carried by the person with diabetes and the caregiver(s), respectively. Few large studies have explored real-world associations between sharing and following, CGM utilization, and glycemic outcomes.
Methods
We performed a retrospective evaluation of device usage and glycemic control in 15,000 youth ranging in age from 2 to 18 years by analyzing anonymized data that had been uploaded with a mobile app that provides optional sharing. The presence or absence of a real-time monitor (a “Follower”) was established on 15 June 2018. Each day with ≥ 1 uploaded glucose values was counted as a day of device usage. Between-group glucose comparisons were made with two-sided Welch’s
t
tests.
Results
Overall, 94.8% of the population used the sharing feature and had at least one Follower. The mean numbers of Followers for patients aged 2–5, 6–12, and 13–18 years were 2.8, 2.8, and 2.4, respectively. In all three age categories, the presence of at least one Follower was associated with lower mean glucose values, more glucose values in the 70- to 180-mg/dL range, correspondingly fewer glucose values representing hypoglycemia and hyperglycemia, and significantly more device utilization.
Conclusion
Real-time sharing and following of CGM data are associated with improved device utilization and glycemic parameters. The observed association suggests either more timely interventions or higher levels of engagement among the caregivers or the youth with diabetes.
Funding
Dexcom, Inc.
Background:
Frequent real-time continuous glucose monitoring (rtCGM) data viewing has been associated with reduced mean glucose and frequent scanning of an intermittently scanned continuous glucose ...monitoring (isCGM) system has been associated with reduced hypoglycemia for patients with diabetes. However, requiring patients to frequently interact with their glucose monitoring devices to detect actual or impending hypoglycemia is burdensome. We hypothesized that a predictive low glucose alert, which forecasts glucose ≤55 mg/dL within 20 minutes and is included in a new rtCGM system, could mitigate hypoglycemia without requiring frequent device interaction.
Methods:
We analyzed estimated glucose values (EGVs) from an anonymized convenience sample of 15,000 patients who used Dexcom G6 (Dexcom, Inc, San Diego, CA, USA) and its mobile app for at least 30 days with or without the “Urgent Low Soon” alert (ULS) enabled. Screen view frequency was determined as the frequency with which the trend screen was accessed on the app. Multiple screen views within any 5-minute interval were counted as one. Hypoglycemia exposure for patients in the top and bottom quartiles of screen view frequency (>8.25 and <3.30 per day, respectively) was calculated as the percentage of EGVs below various thresholds.
Results:
Over 93% of users enabled the ULS alert; its use was associated with significantly reduced hypoglycemia <55 and <70 mg/dL, independent of screen view frequency.
Conclusion:
Use of the G6 ULS alert may disencumber rtCGM users by promoting significant reductions in hypoglycemia without requiring frequent device interactions.
A search for physics beyond the Standard Model (SM) is performed in events with final states including hadronic activity, missing energy, and significant momentum imbalance as measured with the MT2 ...variable. The results are based on data collected by the Compact Muon Solenoid detector at the Large Hadron Collider, and correspond to a total integrated luminosity of 35.9fb–1 of proton-proton collisions at a center-of-mass energy of 13TeV. No significant excess above the predicted SM background is observed. The results are interpreted as 95% confidence-level exclusion limits on the masses of hypothesized particles in a variety of simplified models of R-parity conserving supersymmetry (SUSY). Additional techniques for extending the search to target final states with low-momentum leptons is discussed, interpreted in in the context of SUSY models with compressed mass spectra, and compared to the exclusion strength of a typical all-hadronic search targeting such models.
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