{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T06:03:20Z","timestamp":1790229800163,"version":"4.1.0"},"reference-count":32,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Technology &amp; Therapeutics"],"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate long-term trends in metabolic outcomes among people living with type 1 diabetes (T1D) within a nationwide structured care program in Belgium with full reimbursement of diabetes technologies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Repeated cross-sectional analyses were performed across three audit periods (2010\u20132011, 2017\u20132018, and 2023\u20132024). Outcomes included glycated hemoglobin (HbA1c), low-density lipoprotein (LDL) cholesterol, systolic blood pressure (SBP), and body mass index. Trends were analyzed using generalized estimating equations adjusted for age, sex, diabetes duration, insulin delivery, and glucose monitoring modalities. In 2023\u20132024, glycemic outcomes were compared across technology use, including hybrid closed-loop (HCL) therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In adults, HbA1c decreased from 7.9% (62.8 mmol\/mol) to 7.5% (58.5 mmol\/mol,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), with target attainment (&lt;7%; &lt;53 mmol\/mol) increasing from 22.3% to 35.1%. In children and adolescents, HbA1c declined from 8.0% (63.5 mmol\/mol) to 7.6% (59.0 mmol\/mol,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01), and target attainment rose from 19.7% to 33.1% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Continuous glucose monitoring (CGM) exceeded 90% by 2023\u20132024, while insulin pump use reached 25% in adults and 47% in younger individuals. In adults, HCL therapy was associated with lower HbA1c (7.0%; 53.5 mmol\/mol), higher time-in-range (73%), and lower time-below-range (1.5%) compared with other modalities (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). LDL cholesterol improved, with target attainment (&lt;70 mg\/dL; &lt;1.8 mmol\/L) increasing from 18.3% to 37.4% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), and from 15.5% to 46.5% among those with cardiovascular disease (&lt;55 mg\/dL; &lt;1.4 mmol\/L,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). SBP remained stable. Obesity prevalence increased in all age groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Over 14 years, glycemic and lipid outcomes improved alongside near-universal CGM use and increasing adoption of HCL therapy. However, rising obesity and persistent smoking-related risks highlight the need for targeted prevention strategies. These real-world data confirm that benefits seen in clinical trials translate into durable population-level improvements and support integrated care models for implementing diabetes technology effectively.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15209156261464233","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T07:33:23Z","timestamp":1782977603000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Technology Introduction on Glycemic Control of People Living with Type 1 Diabetes in Belgium: An Observational, Real-World Study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9942-8263","authenticated-orcid":false,"given":"Astrid","family":"Lavens","sequence":"first","affiliation":[{"name":"Health Services Research, Sciensano, Brussels, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Christophe","family":"Philips","sequence":"additional","affiliation":[{"name":"Department of Diabetology, Nutrition, and Metabolic Diseases, CHU Li\u00e8ge, Li\u00e8ge, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"De Block","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetology, and Metabolism, Antwerp University Hospital \u2013 University of Antwerp, Antwerp, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Crenier","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, H\u00f4pital Universitaire de Bruxelles (HUB)\u2014H\u00f4pital Erasme, Brussels, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Oriot","sequence":"additional","affiliation":[{"name":"Department of Diabetology and Endocrinology, Hospital Centre, Mouscron Hospital Centre, Mouscron, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Vandenbroucke","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Mechelen, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvie","family":"Tenoutasse","sequence":"additional","affiliation":[{"name":"Department for Pediatric Endocrinology and Diabetology, Universitaire de Bruxelles (HUB)\u2014H\u00f4pital Universitaire des Enfants Reine Fabiola (HUDERF), Brussels, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke","family":"den Brinker","sequence":"additional","affiliation":[{"name":"Department for Pediatric Endocrinology and Diabetology, Antwerp University Hospital\u2014University of Antwerp, Antwerp, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Van Aken","sequence":"additional","affiliation":[{"name":"Diabetes Center for Children and Adolescents, University Hospital of Ghent, Ghent, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Nobels","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, AZORG, Aalst, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal","family":"Mathieu","sequence":"additional","affiliation":[{"name":"Clinical and Experimental Endocrinology, University Hospitals Leuven-KUL, Leuven, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Belgian Group of Experts IQED and IQECAD L. 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