From the Guidelines
HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) is a mathematical formula used to estimate insulin resistance from fasting blood glucose and insulin levels, calculated as the product of fasting glucose and insulin, divided by 22.5, serving as a surrogate for insulin resistance in non-diabetic persons 1. The formula provides a simple and non-invasive way to assess insulin function, which is valuable because insulin resistance often precedes the development of type 2 diabetes and is associated with metabolic syndrome, cardiovascular disease, and other health conditions. Some key points to consider when using HOMA-IR include:
- The calculation is performed by multiplying fasting insulin (in mU/ml) by fasting glucose (in mmol/L) and dividing by 22.5 1.
- The validity of HOMA-IR depends on the ability of insulin secretion to adapt to insulin resistance, which may limit its suitability in overt diabetes 1.
- There is no agreement on a threshold defining insulin resistance using HOMA-IR, and the assays for insulin measurements can vary widely 1.
- Liver disease progression has been associated with persistence or worsening of metabolic abnormalities, including HOMA-IR 1. The use of HOMA-IR can help clinicians identify individuals at risk of developing type 2 diabetes and other health conditions, allowing for early intervention and prevention strategies.
From the Research
Definition of HOMA-IR
- HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) is a method for assessing beta-cell function and insulin resistance (IR) from basal (fasting) glucose and insulin or C-peptide concentrations 2.
- It is a key laboratory index in the assessment of insulin resistance, which is a major global public health problem 3.
Calculation and Estimation of HOMA-IR
- The calculation of HOMA-IR is partly based on plasma glucose determinations, which are prone to important pre-analytical errors 3.
- Glycated hemoglobin (Hb) fractions can be used as an alternative for fasting glucose in calculating HOMA-IR, as they strongly correlate with fasting glucose levels and are more stable analytes 3.
- HOMA-IR can be estimated using a mathematical model, which takes into account fasting insulin and glucose levels 4.
Clinical Applications of HOMA-IR
- HOMA-IR is a simple and useful method for evaluating insulin sensitivity in patients with type 2 diabetes, including those on insulin therapy 5.
- It can be used to assess the effectiveness of antidiabetic therapeutic regimens on insulin resistance and beta-cell activity 4.
- HOMA-IR cut-offs for identifying metabolic syndrome might vary across populations and body mass index (BMI) levels, and the use of cut-off points according to ROC curve may be the better strategy 6.
Advantages and Limitations of HOMA-IR
- HOMA-IR has the advantage of requiring only a single plasma sample assayed for insulin and glucose, making it a less invasive and less labor-intensive method than other tests 2.
- However, the primary input data need to be robust, and the data need to be interpreted carefully, as with all models 2.
- HOMA-IR has been validated against a variety of physiological methods, and it compares favorably with other models 2.