Title: 574: The role of resistin, adiponectin and osteocalcin in predicting the severity of gestational diabetes mellitus (gdm)
Abstract: The role of different adipocytokines in the prediction of GDM has been studied previously, yet the association between their level and glycemic control was not investigated. We performed a prospective study of women with GDM and singletons gestations, in a Fetal-Maternal clinic of a tertiary medical center. In addition to the routine evaluation, a laboratory workup which included fasting blood samples for blood count, chemistry, glucose and insulin, and ELISA was done. Samples for ELISA were centrifuged and frozen at minus 20°C. We also evaluated insulin resistance and sensitivity using the HOMA-IR and QUICKI models, respectively. Each patient received dietary consultation and instructed to follow her glucose levels 6 times daily using a capillary glucose meter. Following one week, second evaluation was performed. Women with poor glycemic control (mean capillary glucose≥105mg/dL or more than 20% of measurements exceeding 95mg/dL at fasting or 120mg/dL 2-hours postprandial), were started on pharmacological therapy (Glyburide or insulin). Women with poor glycemic control were compared with women with good glycemic control. Overall, 75 women were recruited, of which 26 (34.7%) were poorly controlled. Women with poorly controlled GDM were older, and had higher fasting glucose values in the first trimester and on OGTT. They had higher fasting glucose and insulin values at their initial clinic visit and lower values of Resistin and Adiponectin. Their HOMA-IR was higher and QUICKI lower. No difference was found regarding Osteocalcin. In a multivariate logistics regression model, Resistin, HOMA-IR, QUICKI, first trimester fasting glucose, and first visit fasting insulin and glucose (but not Adiponectin) were found to be independently associated with poor glycemic control. Using a ROC curve, Resistin level of 14.98ng/mL had a specificity of 88.5% and an PPV of 46.8% to predict poorly controlled GDM. Resistin level among poorly controlled GDM patients is lower than among patient with good glycemic control, and may be used to predict those who will need pharmacological therapy to achieve glycemic control.View Large Image Figure ViewerDownload Hi-res image Download (PPT)