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