Can Glucose Alarm Fatigue Threaten the Absolute Clinical Benefit of Continuous Glucose Monitoring in Optimal Glucose Management in Children and Adolescents with Type 1 Diabetes? A Narrative Review

Technology has brought about a revolution in the management of type 1 diabetes (T1D). The adoption of continuous glucose monitoring (CGM) and insulin pump therapy in the everyday life of children and adolescents with T1D is a real innovation and the most promising choice for optimizing glycemic control in this population. The incorporation of an alarm system, including notifications, alerts and alarms, warning patients and their parents about glucose levels and upcoming events interfering with safety is an invaluable additional tool for better targeting euglycemia. However, in parallel with clinical benefits of alarm system in ameliorating metabolic control parameters, alarm fatigue was recorded as a phenomenon, negatively affecting everyday life of patients and their caregivers, and as a cause for rejecting or abandoning CGM or pump therapy treatment. There are a few data concerning frequency, consequences and methods of elimination of alarm fatigue among children. As a result, we have conducted a narrative review in order to briefly present the basic philosophy of the existing CGM alarm systems and their positive effect on glycemic management and focus on alarm fatigue; definition, frequency, effect on quality of life and sleep, not only of T1D patients but also of their families, and methods of elimination. Efforts to achieve a more reliable and accurate alarm system and educate on adapting personalized limits and positively interpreting them may protect T1D pediatric population from alarm fatigue and prevent rejection or incomplete use of CGM and insulin pump as the therapeutic choice ensuring the best glycemic control.