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Khalid A Al-Regaiey, Syed Shahid Habib, Ahmed R Alshamasi, Abdullah F Alnuwaybit, Bader A Alwhaibi, Naif M Alsulais, Abdullah I Alothman, Faisal M Alomar, Muhammad Iqbal Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Khalid A Al-Regaiey; Muhammad Iqbal, Email kalregaiey@ksu.edu.sa; imuhammad@ksu.edu.saObjective: Gremlin 1 is a novel adipokine that plays an important role in obesity and type 2 diabetes mellitus (T2DM). In the current study, we aimed to evaluate plasma levels of Gremlin 1 in diabetic and non-diabetic Saudi adult females and its correlation with body composition, glycemic control and lipid profile.Methods: A case–control study was conducted among 41 T2DM and 31 non-diabetic adult age matched females (controls). All patients underwent body composition by bioelectrical impedance analysis, with a commercially available body analyzer. Fasting venous samples were analyzed for glycemic markers and lipids, while plasma Gremlin 1 was measured by ELISA. The results were compared between the two groups and correlated with other anthropometric and adiposity parameters.Results: Gremlin 1 levels were elevated in T2DM patients (345 ± 26 ng/mL) when compared to control subjects (272 ± 16 ng/mL, p < 0.05). Diabetic patients having poor glycemic control had significantly higher Gremlin 1 levels (382 ± 34 ng/mL) compared to patients with good glycemic control (291 ± 37 ng/mL, p < 0.05). Pearson correlation analysis revealed a positive correlation of Gremlin 1 with fat mass (r = 0.246, p = 0.012), HbA1C (r = 0.262, p = 0.008) and HOMA-IR index (r = 0.321, p = 0.001).Conclusion: Our study demonstrates an important role of Gremlin 1 in glycemic control and body adiposity in the pathophysiology of obesity and T2DM. Gremlin 1 may emerge as a promising biomarker and therapeutic target in obesity and T2DM.Keywords: Gremlin 1, adiposity, diabetes mellitus, HbA1C, HOMA-IR