PP362 - CONTINUOUS GLUCOSE MONITORING AND NUTRITIONAL ADAPTATIONS IN ADULTS WITH INHERITED METABOLIC DISORDERS (IMDS) PRONE TO HYPOGLYCEMIA: A RANDOMIZED CROSSOVER STUDY

PP362

CONTINUOUS GLUCOSE MONITORING AND NUTRITIONAL ADAPTATIONS IN ADULTS WITH INHERITED METABOLIC DISORDERS (IMDS) PRONE TO HYPOGLYCEMIA: A RANDOMIZED CROSSOVER STUDY

G. Gugelmo^1,*, S. Pivetta¹, L. Lenzini², F. Boscari¹, G. P. Fadini¹, N. Vitturi¹

¹Division of Metabolic Diseases, ²Department of Medicine, Azienda Ospedale Università Padova, Padova, Italy

Rationale: IMDs, such as glycogen storage disorders (GSDs) and congenital hyperinsulinism (CH), are characterized by recurrent hypoglycemia requiring dietary therapy and careful glucose monitoring. Despite widespread use beyond diabetes, evidence comparing Continuous Glucose Monitoring (CGM) alert strategies and their nutritional impact in adults with IMDs remains limited.

Methods: In a prospective randomized crossover study 11 adults with GSDs or CH (median age 35.0 ys [IQR 13.0]; 6 males) were assigned to Dexcom G7 (threshold+predictive alerts) and Dexcom ONE+ (threshold-only alerts) for 30 days each, with a 30-day washout. Dietary intake, glycemic metrics, and patient-reported outcomes were compared using crossover ANCOVA (linear mixed models), adjusting for period and sequence.

Results: Median body mass index was indicative of overweight (26.1 kg/m²[IQR 6.69]). No significant differences were observed between G7 and ONE+ for any dietary or glycemic variable (p>0.05). A trend toward higher energy and protein intake was observed during G7, potentially reflecting dietary adaptations and consistent with significantly higher hypoglycemia-related behaviors during G7 (p=0.04). A significant period effect on energy intake (p=0.03) suggested a novelty effect related to CGM introduction. Median glucose was significantly lower at night than over 24h (p<0.05); time below range (<70 mg/dL) remained consistently low (≤0.80%).

Conclusion: In adults with IMDs, both CGM alert strategies appeared comparable in hypoglycemia exposure. However, predictive alerts may influence hypoglycemia-related behaviors and dietary patterns. As optimal glycemic targets remain poorly defined in IMDs, sustained increases in energy intake may carry long-term cardiometabolic risks, supporting a pragmatic and individualized approach to CGM nutritional management in this population.

Disclosure of Interest: None declared