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In a large pot of boiling salted water, cook gnocchi, stirring occasionally, until al dente according to package instructions. Drain.
Meanwhile, in a large skillet over medium heat, heat 1 tablespoon oil. Add sausage and cook, turning occasionally, until seared and just cooked through, about 8 minutes. Transfer to a cutting board and let cool slightly.
Wipe skillet clean. In same skillet over medium heat, heat remaining 2 tablespoons oil. Add garlic and cook, stirring, until fragrant, about 1 minute. Add sage and tomato paste and stir to combine. Whisk in broth and pumpkin puree; season with salt and pepper. Bring to a boil, then reduce heat to medium-low and simmer, stirring occasionally, until slightly thickened, about 5 minutes.
Meanwhile, slice sausage into coins and return to skillet along with gnocchi. Stir in Parmesan and cream and cook, tossing, until gnocchi is coated in sauce, about 2 minutes.
Stir in nutmeg; season with salt and pepper. Top with Parmesan, parsley, and a few grinds of pepper.