title: Determination of reference values for elevated fasting and random insulin levels and their associations with metabolic risk factors among rural Pakistanis from Sindh Province.
abstract: OBJECTIVE
  To assess insulin levels and their association with metabolic risk factors (family history of diabetes, abnormal glucose tolerance, hypertension, overweight and android obesity) among a representative group of Pakistan.
  
  
  METHODS
  The study data was taken from the database of a population-based survey conducted in Sindh Province, Pakistan, in 1994 to assess the prevalence of diabetes mellitus and impaired glucose tolerance (IGT). Through stratified random sampling; oral glucose tolerance tests were performed in 967 adults; every fifth sample was estimated for fasting and random (2-hour post-75 gm glucose load) insulin levels. The total number of metabolic risk factors was counted for each subject, and their association with insulin levels studied.
  
  
  RESULTS
  Of the 130 subjects, 56.1% were females and 95.4% were Sindhi. The mean age of males and females was 43.84 and 40.61 years, respectively. Family history for diabetes and frequency of overweight had significant positive associations with both fasting and random insulin levels (P < 0.05). Association between hypertension and insulin levels was significant only for random insulin levels, and between android obesity, abnormal glucose tolerance, or male gender and insulin levels only for fasting insulin levels (P < 0.05). Metabolic risk factors had significant positive associations with both fasting (r = 0.351 P = 0.000) as well as random insulin levels (r = 0.364 P = 0.000).
  
  
  CONCLUSIONS
  This paper provides baseline pioneering information applicable to the Pakistani population. Furthermore, the observations made in this study about differences in association of fasting or random insulin levels with various metabolic risk factors highlight the possibility of using either of them for risk assessment. This finding needs to be assessed in a larger and nationally representative sample.
authors.affiliation: Department of Medicine, Baqai Medical University Hospital, Nazimabad, Karachi, Pakistan. research@bideonline.com
authors.forename: Muhammad Yakoob
authors.initials: MY
authors.lastname: Ahmadani
authors.forename: Rubina
authors.initials: R
authors.lastname: Hakeem
authors.forename: Asher
authors.initials: A
authors.lastname: Fawwad
authors.forename: Abdul
authors.initials: A
authors.lastname: Basit
authors.forename: A Samad
authors.initials: AS
authors.lastname: Shera
mesh_terms: D000328:Adult; D005260:Female; D005947:Glucose / Q000378:metabolism; D005951:Glucose Tolerance Test; D006801:Humans; D006973:Hypertension; D007328:Insulin / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D050177:Overweight; D010154:Pakistan; D012016:Reference Values; D012307:Risk Factors; D012424:Rural Population
chemical_list: D007328:Insulin; D005947:Glucose