Continuous glucose monitoring, diabetes distress, and well-being in adults with type 1 diabetes: findings from a National Survey in Lithuania

Background: Continuous glucose monitoring (CGM) has transformed glycemic management in type 1 diabetes (T1D), yet its associations with general well-being remain heterogeneous. Objective: To examine associations between glucose monitoring modality and general well-being among adults with T1D in Lithuania and to explore relationships between diabetes distress, hypoglycemia confidence, and well-being, including within predefined higher-risk subgroups. Methods: A cross-sectional national online survey was conducted between December 2023 and May 2024 among 368 adults with T1D (171 using flash glucose monitoring FGM and 197 using continuous glucose monitoring CGM). Participants completed the WHO-5 Well-Being Index, Diabetes Distress Scale (DDS-17), and Hypoglycemia Confidence Scale. Multivariable logistic regression models were used to identify predictors of good well-being (WHO-5 ≥50) and high hypoglycemia confidence (≥3), adjusting for sociodemographic and clinical factors. Median duration of CGM use was 24 months (IQR 12-36). Results: Compared with FGM users, CGM users reported lower diabetes distress, higher hypoglycemia confidence, and higher median WHO-5 scores. After adjustment, CGM use was independently associated with high hypoglycemia confidence but not with good general well-being. Better glycemic stability (time in range >70%) and absence of recent acute events were independently associated with higher odds of good well-being. In selected higher-risk subgroups (unemployment, frequent non-severe hypoglycemia, and time in range <70%), CGM users more frequently reported good well-being; these findings represent cross-sectional associations. Conclusion: CGM use was associated with improved diabetes-specific emotional outcomes, particularly hypoglycemia confidence. Associations with general well-being appear to operate indirectly through glycemic stability and hypoglycemia-related factors. These findings support integrating CGM into comprehensive, patient-centered diabetes care models, particularly for individuals with elevated psychosocial vulnerability.