Evaluation of citrate-fluoride glycolysis inhibitor and its application in gestational diabetes diagnosis

Abstract

Gestational diabetes (GD) is a pathological condition that threatens the maternal and fetal health. The prevalence depends on the population studied and the laboratory tests, as there is no national or international consensus on this point. Venous blood plasma glucose assay is required for diagnosis in all cases. EDTA-fluoride do not inhibit anaerobic glycolysis during the first two hours post bloodwithdrawal and citrate-fluoride is a more efficient glycolysis inhibitor. This provides a new source of pre-analytical variability in the diagnosis. The aims of the present study were to: a) compare the results obtained with different plasma glucose inhibitors (Heparin in ice-water bath, EDTA-fluoride and citrate-fluoride) processed immediately and after 2 hours of incubation; b) assess whether the use of EDTA-fluoride or citrate-fluoride modifies GD diagnosis. One hundred and ninety adult samples were collected to reach objective “a” and 312 samples from 52 pregnant patients to assess the GD diagnosis following the IADPSG protocol. Results showed that EDTA-fluoride do not inhibit glycolysis efficiently during the evaluated time. Citrate-fluoride achieved a superior glycolysis inhibition, compared to heparin in ice-water bath (gold standard). Citrate-fluoride inhibitor showed a higher sensitivity for the diagnosis of GD. Therefore, it is essential to standardize the pre-analytical phase and the cut-off values for this inhibitor-anticoagulant.