Establishing a Reference Interval for an Estimate of Peripheral Insulin Resistance in a Group of Iraqi People


  • Amjad Al-Naemi Department of Clinical Biochemistry, College of Medicine, University of Mosul, Mosul, Iraq



TyG index, HOMA, Insulin resistance, Reference interval, Surrogate measures


Background and aims: Insulin resistance (IR) is the cornerstone in pathophysiology of T2DM. Identifying people with IR can slow the progress to diabetes. Triglyceride and glucose index (TyG index) is a simple tool to assess IR without insulin measurement. This study aims at establishing the reference interval for TyG index in apparently healthy Iraqis. Material and method: This study involved (77) apparently healthy adults (41 men and 36 women) in Mosul, Iraq. Fasting Serum lipids, glucose and insulin were measured and BMI was calculated. The modified TyG index was calculated and compared to other surrogate measures of IR and its reference interval was calculated. Results: TyG index values were normally distributed and significantly correlated with HOMA-IR, Mc-Auley index, QUICKI, and triglycerides/ HDL-c index (r= 0.322, p= 0.004; r=-0.68, p<0001; r= -0.29, p=0.01; r=0.84, p<0.0001respectively). ANOVA and PostHoc Duncan’s analyses revealed significant differences in mean TyG between (lean people) and (overweight and obese subjects), (p=0.02). BMI- based TyG reference intervals were calculated as (4.11- 4.91) and (4.25- 5.05) respectively. This is the first study in Iraq to set a reference interval for TyG index. Values should be interpreted according to BMI.



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Reddy PH. Can diabetes be controlled by lifestyle activities? Curr Res Diabetes Obes J. 2017;1(4):555568. PMid:29399663

Skyler JS, Bakris GL, Bonifacio E, Darsow T, Eckel RH, Groop L, et al. Differentiation of diabetes by pathophysiology, natural history, and prognosis. Diabetes 2017;66:241-55. PMid:27980006 DOI:

Sagesaka H, Sato Y, Someya Y, Tamura Y, Shimodaira M, Miyakoshi T, et al. Type 2 diabetes: When does it start? J Endocr Soc. 2018;2(5):476-484. PMid:29732459 DOI:

Ormazabal V, Nair S, Elfeky O, Aguayo C, Salomon C, Zuniga FA. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol. 2018;17(1):122. PMid:30170598 DOI:

Heise T, Zijlstra E, Nosek L, Heckermann S, Plum-Mörschel L, Forst T. Euglycaemic glucose clamp: what it can and cannot do, and how to do it. Diabetes Obes Metab. 2016;18(10):962-72. PMid:27324560 DOI:

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Teacher DF, Turner RC. Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412-9. PMid:3899825 DOI:

Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care. 2004;27(6):1487-95. PMid:15161807 DOI:

Gutch M, Kumar S, Razi SM, Gupta KK, Gupta A. Assessment of insulin sensitivity/resistance. Indian J Endocrinol Metab. 2015;19(1):160-4. PMid:25593845 DOI:

Robins SJ, Lyass A, Zachariah JP, Massaro JM, Vasan RS. Insulin resistance and the relation of a dyslipidemia to coronary heart disease. The Framingham heart study. Arterioscler Thromb Vasc Biol. 2011;31(5):1208-14. PMid:21311041 DOI:

Jung UJ, Choi MS. Obesity and its metabolic complications: The role of adipokines and the relationship between obesity, inflammation, insulin resistance, dyslipidemia and nonalcoholic fatty liver disease. Int J Mol Sci. 2014;15(4):6184-223. PMid:24733068 DOI:

Akhtar DH, Iqbal V, Vazquez-Montesino LM, Dennis BB, Ahmed A. Pathogenesis of insulin resistance and atherogenic dyslipidemia in nonalcoholic fatty liver disease. J Clin Transl Hepatol. 2019;7(4):362-70. PMid:31915606 DOI:

Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 2008;6(4):299-304. PMid:19067533 DOI:

Krachler B, Volgyi E, Savonen K, Tylavsky FA, Alén M, Cheng S. BMI and an anthropometry-based estimate of fat mass percentage are both valid discriminators of cardiometabolic risk: A comparison with DXA and bioimpedance. J Obes. 2013;2013:862514. PMid:24455216 DOI:

Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104. PMid:30165516 DOI:

Güemes M, Rahman SA, Hussain K. What is a normal blood glucose? Arch Dis Child. 2016;101(6):569-74. PMid:26369574 DOI:

Warnick GR, Mayfield C, Benderson J, Chen JS, Albers JJ. HDL cholesterol quantitation by phosphotungstate-Mg2+ and by dextran sulfate-Mn2+-polyethylene glycol precipitation, both with enzymatic cholesterol assay compared with the lipid research method. Am J Clin Pathol. 1982;78(5):718-23. PMid:6182791 DOI:

Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499-502. PMid:4337382 DOI:

Lee JS, Chang PY, Zhang Y, Kizer JR, Best LG, Howard BV. Triglyceride and HDL-C dyslipidemia and risks of coronary heart disease and ischemic stroke by glycemic dysregulation status: The Strong Heart study. Diabetes Care. 2017;40(4):529-37. PMid:28122840 DOI:

McAuley KA, Williams SM, Mann JI. Diagnosing insulin resistance in the general population. Diabetes Care. 2001;24:460-4. PMid:11289468 DOI:

Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, et al. Quantitative insulin sensitivity check index: A simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab. 2000;85(7):2402-10. PMid:10902785 DOI:

Hosseini SM. Triglyceride glucose index simulation. J Clin Basic Res. 2017;1(1):11-6. DOI:

Yakushiji H, Goto T, Shirasaka W, Hagiwara Y, Watase H, Okamoto H, et al. Associations of obesity with tracheal intubation success on first attempt and adverse events in the emergency department: An analysis of the multicenter prospective observational study in Japan. PLoS One. 2018;13(4):e0195938. PMid:29672600 DOI:

Mula-Abed WS, Al-Naemi AH. Prevalence of diabetes mellitus in Mosul City: Comparison of 1997 American diabetes association classification with 1985 world health Organization classification. Ann Coll Med Mosul. 2002;28(2):109-16.

Feldman Al, Long GH, Johansson I, Weinehall L, Fhärm E, Wennberg P, et al. Change in lifestyle behaviors and diabetes risk: Evidence from a population-based cohort study with 10 year follow-up. Int J Behav Nutr Phys Act. 2017;14(1):39. PMid:28351358 DOI:

Tam CS, Xie W, Johnson WD, Cefalu WT, Redman LM, Ravussin E. Defining insulin resistance from hyperinsulinemic-euglycemic clamps. Diabetes Care. 2012;35(7):1605-10. PMid:22511259 DOI:

Ascaso JF, Romero P, Real JT, Priego A, Valdecabres C, Carmena R. Insulin resistance quantification by fasting insulin plasma values and HOMA index in a non-diabetic population. Med Clin (Barc). 2001;117(14):530-3. PMid:11707218 DOI:

Lee JM, Okumura MJ, Davis MM, Herman WH, Gurney JG. Prevalence and determinants of insulin resistance among U.S. adolescents: A population-based study. Diabetes Care. 2006;29(11):2427-32. PMid:17065679 DOI:

Yamada C, Mitsuhashi T, Hiratsuka N, Inabe F, Araida N, Takahashi E. Optimal reference interval for homeostasis model assessment of insulin resistance in a Japanese population. J Diabetes Investig. 2011;2(5):373-6. PMid:24843516 DOI:

Kelley DE, Goodpaster BH. Skeletal muscle triglyceride. An aspect of regional adiposity and insulin resistance. Diabetes Care. 2001;24(5):933-41. PMid:11347757 DOI:

Ryysy L, Häkkinen AM, Goto T, Vehkavaara S, Westerbacka J, Halavaara J, et al. Hepatic fat content and insulin action on free fatty acids and glucose metabolism rather than insulin absorption are associated with insulin requirements during insulin therapy in Type 2 diabetic patients. Diabetes. 2000;49(5):749-58. PMid:10905483 DOI:

Navarro-González D, Sánchez-Íñigo L, Pastrana-Delgado J, Fernández-Montero A, Martinez JA. Triglyceride glucose index (TyG index) in comparison with fasting plasma glucose improved diabetes prediction in patients with normal fasting glucose: The Vascular-Metabolic CUN cohort. Prev Med. 2016;86:99-105. PMid:26854766 DOI:

Zheng R, Mao Y. Triglyceride and glucose (TyG) index as a predictor of incident hypertension: A 9- year longitudinal population- based study. Lipids Health Dis. 2017;16(1):175. PMid:28903774 DOI:

Kitae A, Hashimoto Y, Hamaguchi M, Obora A, Kojima T, Fukui M. The triglyceride and glucose index is a predictor of incident nonalcoholic fatty liver disease: A population- based cohort study. Can J Gastroenterol Hepatol. 2019;2019:5121574. PMid:31687367 DOI:

Häggström M. Establishment and clinical use of reference ranges. Wiki J Med. 2014;1(1):1-7. DOI:




How to Cite

Al-Naemi A. Establishing a Reference Interval for an Estimate of Peripheral Insulin Resistance in a Group of Iraqi People. Open Access Maced J Med Sci [Internet]. 2022 Jan. 3 [cited 2023 Mar. 31];10(A):192-7. Available from: