Fatty Acid-Binding Protein 4 - A Novel Biomarker in Diabetic Ketoacidosis in Children

Objective: Fatty acid-binding protein 4 (FABP4) is an adipokine with key regulatory role in glucose, lipid and ketone metabolism. We aimed to determine whether FABP4 may serve as a biomarker of the metabolic derangements in new-onset type 1 diabetes in children.

Research Design and Methods: Clinical and laboratory data were prospectively collected from consecutive children presenting with new onset type 1 diabetes to a tertiary pediatric hospital during 2017. In addition to chemistry and blood gases, serum FABP4 and free fatty acids were collected upon presentation and 48 hours after initiation of insulin treatment. Results: Included in the study were 33 children (mean age 9.3±3.5 years, 52% males) of whom 14 (42%) presented with diabetic ketoacidosis (DKA). Mean FABP4 level was higher in the DKA group compared to the non-DKA group (12.1±8.2 vs. 7.4±6.8 ng/ml, p=0.004, respectively). FABP4 level directly correlated with HbA_1c at presentation and inversely correlated with venous blood pH and bicarbonate levels (pConclusions: Given the key regulatory role of FABP4 in both glucose and lipid metabolism, circulating FABP4 may serve as a novel biomarker for diabetes ketoacidosis in children with new onset type 1 diabetes.