Use of Low-Glucose Alerts and Their Impact on Continuous Glucose Monitoring Outcomes in Real-World Use of the MiniMed...

Hypoglycemia remains a major concern in insulin therapy and has limited intensive glycemic control. Although automated insulin delivery substantially reduces hypoglycemia risk, relatively high low-glucose alert (LA) thresholds (LGAT) remain commonly used. This study evaluated the impact of user-set LGAT on glycemic outcomes.

This retrospective cohort study analyzed anonymized real-world data from 169,487 MiniMed 780G users with type 1 diabetes across Europe, the Middle East, and Africa (August 1, 2024-July 31, 2025). Use of LAs, user-set thresholds, and glycemic metrics was evaluated.

Most users (96%) enabled LGAT, and 36% enabled predictive LGAT. Median, 25th and 75th percentiles of time below 54 and 70 mg/dL remained low and within recommended targets across all alert thresholds overall, in users aged ≤15 years, and overnight. Hypoglycemia targets were achieved by >82% and >90% of users with thresholds <60 and ≥60 mg/dL, respectively. In contrast, time in range (TIR) 70-180 mg/dL and hyperglycemia targets were more frequently achieved with LGAT <60 mg/dL, with 70% and 61% meeting these targets, respectively. Overall, 43% of users with LGAT <60 mg/dL met all glycemic targets versus 31% with thresholds >80 mg/dL.

A LGAT below 60 mg/dL is generally recommended, as it is associated with increased TIR, reduced hyperglycemia, and low time in hypoglycemia. A threshold between 60 and 70 mg/dL may provide a balanced option for those with greater hypoglycemia concerns. These recommendations can optimize system usability and glycemic outcomes while maintaining safety and minimizing alarm burden.