The Emotional Burden and Behavioral Impacts of Alarms and Alerts Across the Spectrum of Diabetes Technology Use: a Cross-Sectional Study
Abstract
Abstract Background Continuous glucose monitors (CGMs), sensor-augmented pumps (SAPs), and automated insulin delivery (AID) systems have substantially improved glycemic outcomes for people with type 1 diabetes (T1D). However, these technologies also generate frequent alarms and alerts that may contribute to emotional burden, alarm fatigue, and maladaptive behavioral responses. Despite increasing recognition of alarm-related distress, little is known about how alarm burden differs across contemporary diabetes technologies. Objective This study evaluated differences in alarm frequency, emotional burden, and behavioral responses to alarms and alerts among adults using CGMs alone, SAP therapy, and AID systems. Methods We conducted a cross-sectional survey of adults (≥18 years) with T1D receiving care within a large academic health system between August 2024 and March 2025. Eligible participants completed an online survey assessing demographics, diabetes technology use, perceptions of alarm frequency and burden, and responses to alarms and alerts. Participants were categorized as CGM-only, SAP, or AID users. Differences between groups were evaluated using χ2 tests and ANOVA. Ordinal logistic regression models adjusted for age, gender, and diabetes duration were used to examine associations between diabetes technology type and alarm-related outcomes. Results Among 838 respondents (mean age 46.0, SD 16.6 years; mean diabetes duration 23.0, SD 14.0 years; n=457, 55% women), AID…
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