Study of serum insulin, liver profile and protein levels of insulin resistant type-2 diabetics in Pakistani population

Type-2 diabetes mellitus is defined by insulin resistance combined with an altered insulin secretory pattern. Insulin resistance is defined as a lack of sufficient insulin receptors in target tissues, defect in the intracellular transport of glucose and or an altered insulin secretory pattern (dys-synchronization between pancreatic p-cell release of insulin and the body insulin requirements). Three hundred confirmed non-insulin dependent (type-2 diabetics) were randomly selected from the patients attending diabetic clinic of PMRC Research centre, Fatima Jinnah Medical College, Lahore and one hundred and fifty normal control with same age and sex were also selected for the present study. Biochemical testing of fasting and 2 hours serum insulin, serum renal profile, liver profile and protein profile was done by using standard methods and instruments. Serum insulin measurements were made by ELISA/1-Step sandwich assay, while other biochemical investigations were ca rried out on Humalyser 3000 of Boehringer Mannheim W. Germany. Insulin resistance was calculated using the homeostasis model assessment for insulin resistance (HOMA-IR) method. The data collected was then analyzed by the computer program Special Package for Social Sciences (SPSS, Chicago, IL, USA. Plasma glucose levels after an oral glucose challenge were significantly higher (P less than 0.05) in the insulin resistant subjects. Serum insulin levels in type-2 diabetics were found to be raised in fasting condition as well as after 2 hour intervals. Serum alkaline phosphatase levels as well as serum transaminases also showed a statistical significant difference at (P less than 0.05). Circulating concentration of total protein has exhibited a trend of lowering in type-2 diabetics compared to the normal control. Serum albumin concentration in type-2 diabetics also declined in type-2 diabetics while serum globulin in these subjects also became lowered. A/G ratio also disturbed in type-2 diabetics. Insulin resistance measured using the HOMA-IR model was greater and has more intrinsic variability in individuals with type-2 diabetes compared with those without. The HOMA-IR in the type-2 diabetic group was significantly greater than that of the control group (mean plus minus SD 3.84 plus minus 2.3 vs. 1.62 plus minus 0.79 units (P less than 0.05). Present study demonstrates that insulin resistance status in our population very closely correlate to those reported for other developing countries but, however, has slightly difference in that 91.6% of diabetic population belonged to type-2 diabetes, complications of diabetes increases with the duration of the disease, lack of daily exercise, adaptation of western styled foods, urbanization, poverty and lack of proper knowledge about the disease in our country has aggravated the situation. Moreover, two third of the younger population of type-2 diabetes has suffered from the cardiovascular risks which is an a larming situation.