Abstract
BackgroundGlycogen storage disease type 1a (GSD Ia) is characterized by severe fasting hypoglycemia. The clinical management includes the administration of uncooked cornstarch (UCCS). Although such a diet approach is effective in achieving euglycemia, its impact on the quality of life of patients should be considered. In vitro analyses suggest a longer release of glucose when using sweet manioc starch (SMS).MethodsWe compared the efficacy and safety of the administration of SMS and UCCS during a short-fasting challenge in patients with GSD Ia in a randomized, triple-blind, phase I/II, cross-over study. GSD Ia patients aged ≥ 16 years and treated with UCCS were enrolled. Participants were hospitalized for two consecutive nights, receiving UCCS or SMS in each night. After the administration of the starches, glucose, lactate and insulin levels were measured in 1-h interval throughout the hospitalization period. The procedures were interrupted after 10 h of fasting or in a hypoglycemic episode (< 3.88 mmol/L).ResultsEleven individuals (mean age: 21.6 ± 4.3 years; all presenting body mass index > 25 kg/m2) participated in the study. The average fasting period was 8.2 ± 2.0 h for SMS and 7.7 ± 2.3 h for UCCS (p = 0.04). SMS maintained euglycemia for a greater period over UCCS. Increased lactate concentrations were detected even in absence of hypoglycemia, not being influenced by the different starches investigated (p = 0.17). No significant difference was found in total cholesterol, HDL, triglycerides and uric acid levels in both arms. None of the patients showed severe adverse events.ConclusionsSMS appears to be non-inferior to UCCS in the maintenance of euglycemia, thus emerging as a promising alternative to the treatment of GSD Ia.
Highlights
Glycogen storage disease type 1a (GSD Ia) is characterized by severe fasting hypoglycemia
The clinical management is based on dietary treatment to maintain euglycemia and prevent secondary metabolic disorders [7]
The authors concluded that the use of Waxy Maize 20 (WMHM20) resulted in a longer duration of euglycemia and better short-term metabolic control
Summary
Glycogen storage disease type 1a (GSD Ia) is characterized by severe fasting hypoglycemia. The clinical management includes the administration of uncooked cornstarch (UCCS). Such a diet approach is effective in achieving euglycemia, its impact on the quality of life of patients should be considered. Glycogen Storage Diseases comprise distinct genetic disorders caused by alterations in the synthesis or degradation of glycogen [1]. Glycogen storage disease type 1a (GSD Ia), typically known as Von Gierke disease (OMIM #232200), is an autosomal recessive metabolic disorder. The clinical management is based on dietary treatment to maintain euglycemia (blood glucose > 4 mmol/L or 70 mg/dL) and prevent secondary metabolic disorders [7]
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