Belgium Study: Managing Type 1 Diabetes During Pregnancy

Belgian Experts Update Guidelines for Type 1 Diabetes in Pregnancy

A study from Belgium, published in The Lancet Diabetes & Endocrinology, offers a comprehensive update on how women with type 1 diabetes can best manage their condition during pregnancy. Researchers from the University Hospital Gasthuisberg at KU Leuven — one of Europe's leading diabetes centers — reviewed the latest evidence on lifestyle, medications, and cutting-edge technologies to help mothers and babies stay safe.

What the Belgian Researchers Found

The research team confirmed that keeping blood glucose levels within a healthy target range is the cornerstone of a safe pregnancy for women with type 1 diabetes. The recommended pregnancy-specific target is more than 70% Time in Range (TIRp) — meaning glucose should stay between 63–140 mg/dL (3.5–7.8 mmol/L) for at least 70% of the day.

However, the Belgian review revealed a concerning reality: most women with type 1 diabetes only reach this target in the final weeks of pregnancy — far too late to meaningfully reduce risks like pre-eclampsia, preterm birth, and complications for the newborn.

Additional protective strategies highlighted in the review include:

• Appropriate gestational weight gain tailored to pre-pregnancy BMI
• Healthy lifestyle habits including balanced nutrition and safe physical activity
• Antihypertensive treatment when blood pressure rises
• Low-dose aspirin to reduce pre-eclampsia risk — consistent with current US recommendations from ACOG

The Promise of Hybrid Closed-Loop Insulin Systems

Perhaps the most exciting finding involves Hybrid Closed-Loop (HCL) insulin delivery systems — often called an "artificial pancreas." These devices automatically adjust insulin delivery based on real-time continuous glucose monitor (CGM) readings. Belgian and international clinical trials show these systems are emerging as one of the most effective tools for helping pregnant women with type 1 diabetes stay in range earlier in pregnancy, not just at the end.

Why This Matters for US Patients

In the United States, the American Diabetes Association (ADA) similarly recommends a Time in Range above 70% during pregnancy, with glucose targets between 63–140 mg/dL. What makes this Belgian review especially valuable for American patients is its emphasis on when that target is achieved — not just whether it is. Many US women with type 1 diabetes also struggle to hit these goals until late in pregnancy.

The Belgian team's endorsement of HCL systems aligns with growing availability in the US. Devices such as the Omnipod 5 and Tandem Control-IQ are FDA-cleared, though access can vary by insurance coverage. This international research adds important weight to advocacy efforts for broader US insurance coverage of these life-changing technologies.

The review also stresses psychosocial support — addressing the emotional and mental health burden of managing type 1 diabetes through pregnancy. This is an area where US care teams, including diabetes educators and mental health professionals, can play a critical role.

Talk to Your Care Team

If you have type 1 diabetes and are pregnant or planning a pregnancy, ask your endocrinologist about CGM technology, hybrid closed-loop systems, and aspirin prophylaxis. Early intervention — ideally starting before conception — gives you and your baby the best possible start.

Source: Benhalima K, Beunen K, Siegelaar S. "Management of type 1 diabetes in pregnancy: update on lifestyle, pharmacological treatment, and novel technologies for achieving glycaemic targets." The Lancet Diabetes & Endocrinology. 2023. PMID: 37290466. DOI: 10.1016/S2213-8587(23)00116-X