A prospective study on continuous glucose monitoring in glycogen storage disease type Ia: towards glycemic targets

CONTEXT: Although previous research has shown the benefit of continuous glucose monitoring (CGM) for hepatic glycogen storage diseases (GSDs), current lack of prospectively collected CGM metrics and glycemic targets for CGM-derived outcomes in the hepatic GSD population limits its use.

OBJECTIVE: To assess CGM metrics for glycemic variation and glycemic control in adult patients with GSDIa as compared to matched healthy volunteers.

DESIGN: Prospective CGM data were collected during the ENGLUPRO GSDIa trial (NCT04311307) in which a Dexcom G6 device was used. Ten adult patients with GSDIa and 10 age-, gender- and BMI-matched healthy volunteers were enrolled. Capillary blood glucose (CBG) was concurrently measured during two standardized 2-hour time intervals. Descriptive (e.g., glycemic variability (GV), time-below-range (TBR), time-in-range (TIR), time-above-range (TAR)) and advanced (i.e., 1 st and 2 nd order derivatives, Fourier analysis) CGM outcomes were calculated. For each descriptive CGM outcome measure 95%CI were computed in patients with GSDIa and healthy volunteers, respectively.

RESULTS: CGM overestimation was higher under preprandial and level 1 hypoglycemia (i.e. capillary glucose values ≥3.0 mmol/L and < 3.9 mmol/L) conditions. GV and TAR were higher while TIR was lower in patients with GSDIa compared to healthy volunteers (p<0.05). Three patients with GSDIa showed descriptive CGM outcomes outside the calculated 95%CI in GSDIa patients. Advanced CGM analysis revealed a distinct pattern (i.e. 1 st and 2 nd order derivatives and glucose curve amplitude) in each of these 3 patients within the patients group.

CONCLUSIONS: This is the first study to prospectively compare CGM outcomes between adult patients with GSDIa and matched healthy volunteers. The generation of a set of CGM metrics will provide guidance in using and interpreting CGM data in GSDIa and will be useful for the definition of glycemic targets for CGM in patients with GSDIa. Future studies should investigate the prognostic value of CGM outcomes and their major determinants in patients with GSDIa.