Understanding the benefits and psychological burdens of using continuous glucose monitoring for lifestyle change: A mixed-methods cross-sectional study

Background: Continuous glucose monitoring (CGM) is increasingly used by people with and without diabetes to support lifestyle change. While CGM's efficacy as a behavior change tool is proven, its potential to cause distress remains underexplored. This study assessed CGM-related distress in adults not using insulin and examined associations with baseline characteristics, psychological traits, and qualitative experiences. Methods: A multi-method, cross-sectional digital questionnaire was administered to adults with and without diabetes not on insulin who had used CGM within the past year. Quantitative data included participant characteristics, psychological traits, and ratings of CGM-related distress. Qualitative data were gathered through five open-ended questions and analyzed thematically. Results: Fifty-six adults were included. CGM-related distress varied widely. Regardless of diabetes status, more than two-thirds of participants (68 %) reporting fear of type 2 diabetes when observing high glucose levels. Younger age and obesity were associated with greater distress (p < 0.01). Agreeableness was associated with greater fear and unhappiness in response to observing elevated glucose levels (r > 0.3, p < 0.01), while higher eating disorder symptoms correlated with distress over CGM's appearance (r > 0.3; p < 0.01). Qualitative themes revealed that despite distress, most participants (89 %) reported positive dietary and/or physical activity changes in response to CGM. Conclusions: While CGM facilitates healthy lifestyle changes, it may also contribute to distress, particularly among younger adults and those with obesity, high agreeableness and eating disorder symptoms. Qualitative findings indicated distress often coexisted with reported behavior change, suggesting it may act as a motivator and barrier. Future research should develop validated tools to measure CGM-related distress and clarify its role in behavior change.