**8. Ethical considerations**

The study was carried out in accordance with the Declaration of Helsinki. Informed consent was obtained from all the patients for the initial study. The protocol was approved by the Medical Ethics Committee of the Faculty of Medicine, Benghazi University, Benghazi,Libya. Additional informed consent was obtained for the present study.

Results: Table.1. shows the differences in waist circumferences reported for various ethnic groups


#### **Table 1.** Ethnic differences in Waist circumferences


**Table 2.** World Health Organization (WHO) cut off points and risk of Metabolic complications[9]

The mean BMI in Libyan adults is reported to be 27.7 kg/m2 (26.4 kg/m2 in men and 29 kg/m2 in women), and the mean waist circumference is 93.3 cm. [10] In the present study compared to other ethnic groups Libyan Men and women have higher BMI and Waist circumference carrying higher risk for metabolic complications as well as for chronic diseases. (BMI 25-30; (29.5) and 30 to 35 (34.5)respectively in normal as well as obese controls). Waist circumference 104cm; 114 cm for normal and obese subjects respectively; Waist circumference to Hip circumference; 0.97 for both men and women subjects.(W/H ratio). The normal control group had higher BMI as well as higher waist circumference indicating both subcutaneous fat and visceral fat are increased in the subjects studied.


\*Adapted from Chin Meng Khoo et al.[11] \*\* present study

\*P value for comparison between the ethnic groups in men; †P value for comparison between the ethnic groups in women. The values for adiponectin for both Libyan men and women were comparatively lower than the values report‐ ed for other ethnic groups like Chinese, Malay, Asian Indian groups.

**Table 3.** Ethnic variation in Serum Adiponectin levels


**Table 4.** Serum Adiponectin, Leptin and Resistin levels in normal, obese and Diabetic Libyan patients

**Country or Ethnic group Sex Waist Circumference(cm)**

>94 >80

>90 >80

>90 >80

>94 >80

>93 >90

**Indicator Cut off Points Risk of Metabolic complications**

The mean BMI in Libyan adults is reported to be 27.7 kg/m2 (26.4 kg/m2 in men and 29 kg/m2 in women), and the mean waist circumference is 93.3 cm. [10] In the present study compared to other ethnic groups Libyan Men and women have higher BMI and Waist circumference carrying higher risk for metabolic complications as well as for chronic diseases. (BMI 25-30; (29.5) and 30 to 35 (34.5)respectively in normal as well as obese controls). Waist circumference 104cm; 114 cm for normal and obese subjects respectively; Waist circumference to Hip circumference; 0.97 for both men and women subjects.(W/H ratio). The normal control group had higher BMI as well as higher waist circumference indicating both subcutaneous fat and

**Males-Total Adiponectin(µg/ml)** *3.10±1.79 2.97±1.80 2.97±1.75 1.97±1.05 0.01* **Females(Total Adiponectin(µg/ml)** *4.60±2.50 4.28±2.52 3.83±1.95 2.45±1.10 0.001*

\*P value for comparison between the ethnic groups in men; †P value for comparison between the ethnic groups in women. The values for adiponectin for both Libyan men and women were comparatively lower than the values report‐

*\*Chinese \*Malay \*Asian Indian \*Libyan P Anova*

Men women

Men Women

Men Women

\*Men Women

Men Women

Waist circumference >94cm(M), >80cm(W) Increased

Waist circumference >102cm(M), >88cm(W) Substantially increased W/H ratio >0.90(M), >0.85(w) Substantially increased

**Table 2.** World Health Organization (WHO) cut off points and risk of Metabolic complications[9]

Source \*Adapted from Zimmet and Alberti [2006] [8]; \*\* present study

**Table 1.** Ethnic differences in Waist circumferences

visceral fat are increased in the subjects studied.

\*Adapted from Chin Meng Khoo et al.[11] \*\* present study

**Table 3.** Ethnic variation in Serum Adiponectin levels

ed for other ethnic groups like Chinese, Malay, Asian Indian groups.

\*South Asian

108 Treatment of Type 2 Diabetes

\*Chinese

\*Japanese

\*Europid

\*\*Libyan

M: men; W: women

The serum levels of adiponectin did not show significant difference in their values between controls and obese subjects.The adiponectin level in diabetic subjects is significantly higher than the control subjects. The serum levels of leptin and resistin were significantly higher for obese and T2DM compared to normal controls.


**Table 5.** Serum glucose, glycated hemoglobin (HbA1c) and Lipid Profile in the Libyan Subjects

There was no marked differences between the control group and obese group with respect to the serum levels of glucose, HbA1c, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides. There were marked increases in total cholesterol, LDL cholesterol, triglycerides with a marked fall in HDL cholesterol in diabetec subjects (dyslipidemia)

A marked increase was observed in non-HDL cholesterol in obese and diabetics compared to the control group.

The levels of serum total cholesterol and HDL cholesterol are comparatively lower for local Libyan subjects when compared to South Asians and Non South Asians.


**Table 6.** Serum lipid profile in different ethnic groups
