The Emotional Burden and Behavioral Impacts of Alarms and Alerts Across the Spectrum of Diabetes Technology Use: a Cross-Sectional Study

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 users reported the highest alarm frequency, with 49% (n=252) experiencing alarms several times daily, compared with 35% (n=28) of SAP users and 32% (n=79) of CGM-only users (P<.001). AID users also reported greater alarm disruptiveness, annoyance, and unwanted attention than CGM-only users. Overcorrection of glucose levels in response to alerts was common across all technologies: 44% (n=371) and 50% (n=419) of participants reported sometimes overcorrecting low and high glucose levels, respectively, while 32% (n=265) and 18% (n=147) reported often or always overcorrecting low and high glucose levels, respectively. After adjustment, AID users had greater odds of frequent alarms (odds ratio [OR] 1.98, 95% CI 1.48-2.65), alarm disruptiveness (OR 1.67, 95% CI 1.24-2.25), annoyance (OR 1.65, 95% CI 1.23-2.19), unwanted attention (OR 1.85, 95% CI 1.38-2.47), ignoring alarms (OR 1.86, 95% CI 1.40-2.47), and overcorrecting low glucose levels (OR 1.61, 95% CI 1.20-2.15) compared with CGM-only users. Perceived effectiveness of alarms did not differ by technology type. Conclusions: Although AID systems provide important clinical benefits, they are associated with the greatest alarm and alert burden. Alarm-driven behaviors, including ignoring alerts and overcorrecting glucose levels, represent previously underrecognized consequences of diabetes technology that may diminish user experience and potentially affect glycemic management. These findings identify opportunities to improve alert algorithms while highlighting the need for individualized patient education, clinician engagement in setting appropriate alert thresholds, and routine assessment of alarm burden to optimize both glycemic outcomes and patient-centered experiences with diabetes technology.