Slightly adapted from I was Born to Cook
1 small onion, chopped
4 garlic cloves, chopped
1 tsp crushed red pepper flakes
1 (15 oz) can pumpkin puree
1 tablespoon dried sage
1/3 cup heavy cream (half and half or 2 % milk will work too)
½ cup Parmesan Cheese
In a large pan brown sausage, until cooked through. Remove from pan and drain over paper towel. Set aside.
Using any oil (up to 2 Tbls) from the sausage, sauté onion, garlic and crushed red pepper until soft. Stir in pumpkin, chicken stock and sage. Bring to a boil, then simmer for 5 minutes. Add a pinch of salt.
Stir in heavy cream and sausage. Reduce heat to low and simmer until sauce comes together and thickens slightly. Remove from heat, and add pasta. Toss everything together.
Place mixture in a casserole dish sprayed with non stick spray. Top with Parmesan Cheese. Bake for about 30-35 minutes, until top is golden brown.