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We report two siblings who were diagnosed with GSD1b in adulthood. Both had a normal fasting tolerance throughout childhood and, as adults, were able to fast for at least 16\u2009h without developing hypoglycaemia. The older sibling developed nodular cirrhosis during adolescence. The younger sibling exhibited a more pronounced metabolic phenotype, including hyperuricaemia leading to recurrent gout and nephrolithiasis. He experienced occasional episodes of mild neutropenia that were corrected with empagliflozin treatment. To our knowledge, these represent the first reported patients with GSD1b presenting in adulthood with non\u2010hypoglycaemic complications of the disease and without overt neutropenia or neutrophil dysfunction.<\/jats:p>","DOI":"10.1002\/jmd2.70079","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T22:57:20Z","timestamp":1773010640000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Outcomes and Management in Late Diagnosed Siblings Affected With Attenuated\n                    <scp>GSD<\/scp>\n                    Ib"],"prefix":"10.1002","volume":"67","author":[{"given":"Gregory","family":"Lynch","sequence":"first","affiliation":[{"name":"Clinical Biochemistry Department Northern Care Alliance NHS Foundation Trust  Salford UK"},{"name":"Adult Inherited Metabolic Diseases Northern Care Alliance NHS Foundation Trust  Salford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison","family":"Woodall","sequence":"additional","affiliation":[{"name":"Adult Inherited Metabolic Diseases Northern Care Alliance NHS Foundation Trust  Salford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Dawson","sequence":"additional","affiliation":[{"name":"Adult Inherited Metabolic Disorders University Hospitals Birmingham NHS Foundation Trust  Birmingham UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Newsome","sequence":"additional","affiliation":[{"name":"Faculty of Life Sciences and Medicine, King's College London, Foundation for Liver Research &amp; King's College Hospital Roger Williams Institute of Liver Studies  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2968-7374","authenticated-orcid":false,"given":"Maria","family":"Veiga\u2010da\u2010Cunha","sequence":"additional","affiliation":[{"name":"Groupe de Recherches Metaboliques, de Duve Institute UCLouvain  Brussels Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0148-6332","authenticated-orcid":false,"given":"Karolina M.","family":"Stepien","sequence":"additional","affiliation":[{"name":"Adult Inherited Metabolic Diseases Northern Care Alliance NHS Foundation Trust  Salford UK"},{"name":"Division of Cardiovascular Sciences University of Manchester  Manchester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/hmg\/11.25.3199"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1816143116"},{"key":"e_1_2_13_4_1","volume-title":"GeneReviews","author":"Bali D. 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