CYSTATIN C AS A SCREENING BIOMARKER OF GESTATIONAL DIABETES MELLITUS
Objective: To evaluate cystatin C as a screening biomarker for early detection of gestational diabetes mellitus (GDM).
Study Design: Case control study.
Place and Duration of Study: Army Medical College and Pak Emirates Military Hospital, from Dec 2017 Jun 2018.
Methodology: This case control study was conducted at department of Chemical Pathology, Army Medical College and Pak Emirates Military Hospital Rawalpindi. A total of 30 women with gestational diabetes (cases) and 30 healthy pregnant women (control) were recruited in the study. HbA1c, cystatin C and insulin levels were performed on samples of all the participants. Seventy-five gram OGGT was performed on all subjects. Paired t-test and Odds ratio were calculated for cases and controls.
Results: The cystatin C levels were high with increasing parity. Paired sample t test showed strong association of cystatin C to HbA1c, fasting and post load glucose levels in patients of GDM (HbA1c t (60)=36.0, p<0.001, Fasting glucose t (60) = 34.3, p<0.001, One-hour glucose t (60)=27.6, p<0.001 and Two hours glucose t (60)=22.9, p<0.001). Adjusted odds ratios (OR) based on cut off value of cystatin C (>0.95) of maternal plasma showed positive association with one-hour (OR=4.7) and two-hour (OR=4.3) post load plasma glucose levels in OGTT.
Conclusion: This study strongly suggested that cystatin C may be used as preliminary screening biomarker for early detection of GDM. Patients having elevated levels of cystatin C then can be further evaluated using OGTT. This two-step approach has potential to rationalize the diagnostic work up of this category of patients and would also result in evidence-based patient management.