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Mol Genet Metab. 2019 Feb 28. pii: S1096-7192(19)30036-8. doi: 10.1016/j.ymgme.2019.02.008. [Epub ahead of print]

Glycemic control and complications in glycogen storage disease type I: Results from the Swiss registry.

Author information

1
Department of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland.
2
Department of Pediatrics and Institute of Clinical Chemistry, University Hospital Bern, Inselspital, Bern, Switzerland.
3
Department of Diabetes, Endocrinology, Nutritional medicine and Metabolism, University Hospital Bern, Inselspital, Bern, Switzerland.
4
Department of Endocrinology, Diabetes and Metabolism, University Hospital, Basel, Switzerland.
5
Division of Metabolism and Children's Research Center (CRC), University Children's Hospital, Zurich, Switzerland; radiz - Rare Disease Initiative Zurich, Clinical Research Priority Program for Rare Diseases, University of Zurich, Switzerland.
6
Department of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland; radiz - Rare Disease Initiative Zurich, Clinical Research Priority Program for Rare Diseases, University of Zurich, Switzerland.
7
Department of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland; radiz - Rare Disease Initiative Zurich, Clinical Research Priority Program for Rare Diseases, University of Zurich, Switzerland. Electronic address: michel.hochuli@usz.ch.

Abstract

BACKGROUND:

Regular carbohydrate intake to avoid hypoglycemia is the mainstay of dietary treatment in glycogen storage disease type I (GSDI). The aim of this study was to evaluate the quality of dietary treatment and glycemic control in a cohort of GSDI patients, in relation to the presence of typical long-term complications.

METHODS:

Data of 25 patients (22 GSD subtype Ia and 3 GSDIb, median age 20y) from the Swiss hepatic glycogen storage disease registry was analyzed cross-sectionally. Frequency and type of hypoglycemia symptoms were assessed prospectively using a structured questionnaire. Diagnostic continuous glucose monitoring (CGM) was performed as part of usual clinical care to assess glycemic control in 14 patients, usually once per year with a mean duration of 6.2 ± 1.1 consecutive days per patient per measurement.

RESULTS:

Although maintenance of euglycemia is the primary goal of dietary treatment, few patients (n = 3, 13%) performed capillary blood glucose measurements regularly. Symptoms possibly associated with hypoglycemia were present in 13 patients (57%), but CGM revealed periods of low glucose (<4 mmol/l) in all patients, irrespective of the presence of symptoms. GSDIa patients with liver adenomas (n = 9, 41%) showed a higher frequency and area under the curve (AUC) of low blood glucose than patients without adenomas (frequency 2.7 ± 0.8 vs. 1.5 ± 0.7 per day, AUC 0.11 ± 0.08 vs. 0.03 ± 0.02 mmol/l/d; p < 0.05). Similarly, the presence of microalbuminuria was also associated with the frequency of low blood glucose. Z-Scores of bone density correlated negatively with lactate levels.

CONCLUSION:

The quality of glucose control is related to the presence of typical long-term complications in GSDI. Many patients experience episodes of asymptomatic low blood glucose. Regular assessment of glucose control is an essential element to evaluate the quality of treatment, and increasing the frequency of glucose self-monitoring remains an important goal of patient education and motivation. CGM devices may support patients to optimize dietary therapy in everyday life.

KEYWORDS:

Adenoma; Bone; CGM; GSD; Glucose; Glycogen storage disease; Nephropathy

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