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Review
. 2025 Jul 16;17(1):276.
doi: 10.1186/s13098-025-01797-3.

Glucose alarms approach with flash glucose monitoring system: a narrative review of clinical benefits

Marcio Krakauer  1 , Solange Travassos  2 , Melanie Rodacki  2   3 , Monica A L Gabbay  4 , André G D Vianna  2   5 , Mauro Scharf  5 , Rodrigo N Lamounier  6 , Denise Reis Franco  7 , Levimar Rocha Araújo  8 , Luis Eduardo Calliari  9
Affiliations
Review

Glucose alarms approach with flash glucose monitoring system: a narrative review of clinical benefits

Marcio Krakauer et al. Diabetol Metab Syndr. .

Abstract

Attaining an adequate glycemic control has been associated with a better prognosis and with a reduction in the risk of developing long-term microvascular and macrovascular diabetic complications. Continuous glucose monitoring (CGM) has been shown to improve glycemic control and reduce blood glucose variability. Furthermore, CGM is associated with greater treatment adherence and higher satisfaction. Hypoglycemia is the most frequent acute complication in individuals with insulin treated diabetes and may limit the achievement of glycemic control. Furthermore, repeated episodes of hypoglycemia, particularly when a severe hypoglycemia event occurs are associated with adverse outcomes. The introduction of glucose alarms improves not only safety of subjects, but also contributes to improve glycemic control. However, depending on the glycemic thresholds, the frequency of alarms could be perceived as excessive, leading to a state of 'alarm fatigue', limiting the effective response to the alarms by the individual. The optimization of alarm thresholds tailored to individual needs and preferences can enhance the clinical utility of CGM while minimizing alarm fatigue. When alarms occur, their underlying causes should be investigated to enable appropriate corrections and adjustments. CGM systems equipped with alarms, such as FreeStyle Libre 2, have demonstrated efficacy in reducing hyperglycemia and severe hypoglycemic events, leading to improvements in time in range and quality of life of people with diabetes.

Keywords: Diabetes; Flash continuous glucose monitoring; Glucose alarm; Hyperglycemia; Hypoglycemia.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: Marcio Krakauer has received support from Abbott, Roche, Novo, Lilly, Astra, Boehringer. Solange Travassos has received support from Medtronic, Abbott, Novo Nordisk, Astra Zeneca. Melanie Rodackie has received support from Abbott, NovoNordisk. Monica A. L. Gabbay has received support from Abbott, Medtronic, Roche, Sanofi. André Vianna has received support from Abbott, Medtronic, Roche, Novo Nordisk, Sanofi, Lilly, Astra Zeneca. Mauro Scharf has received support as member of advisory boards and/or speaker from Pfizer, Novonordisk, Sanofi, Medtronic, Abbott, Cristalia, Sandoz. He has received honoraria as medical consultant from Biomm Cristalia. He has recieved Travel Grants from Medtronic, Pfizer, Eli Lilly. He is owner of Stock Options from Endomed s/c, Intelmed s/c, G7med s/c, Centro de Diabetes Curitiba ltda, Unilabs AS. He is Technical Manager of Unimed Labs and Unigenne labs. Rodrigo N Lamounier has received support from Abbott, Eli-Lilly, Medtronic, Novo Nordisk. Denise Reis Franco has received support from Abbott, Lilly, Novo Nordisk, Sanofi, Medtronic. Levimar Rocha Araújo has received support from Abbott, Medtronic, Bioom. Luis Eduardo Calliari has received support from Abbott, NovoNordisk, Medtronic.

Figures

Fig. 1
Fig. 1
How to set up Low glucose alert threshold. Based on reference [51]
Fig. 2
Fig. 2
High glucose alert threshold. Based on reference [51]
Fig. 3
Fig. 3
Practical tips about high glucose alert thresholds. 1. Alarms set to usual postprandial glucose levels can lead to overcorrection of insulin (stacking) and lead to hypoglycemia→try to avoid alarms at usual post-meal levels. 2. Use alarms for the early detection of high glucose levels. 3. Use alarms to detect very high glucose levels. 4. Set for lower levels can lead to notification at every meal. Based on references [50, 74]
See this image and copyright information in PMC

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