From the Guidelines
The optimal HOMA-IR value is generally considered to be less than 1.0, with values between 1.0 and 1.9 indicating early insulin resistance, and values above 2.0 signifying significant insulin resistance. This is based on the most recent and highest quality study available, which emphasizes the importance of maintaining a HOMA-IR below 1.0 for optimal metabolic health 1. HOMA-IR is a mathematical model that estimates insulin resistance using fasting glucose and insulin levels, providing a snapshot of insulin sensitivity, with lower values indicating better insulin function.
Key Considerations
- Insulin resistance is a key factor in developing type 2 diabetes and metabolic syndrome, so monitoring and addressing elevated HOMA-IR through lifestyle modifications like weight loss, regular exercise, and a balanced diet rich in whole foods can help improve insulin sensitivity 1.
- The formula for HOMA-IR multiplies fasting glucose (in mmol/L) by fasting insulin (in μIU/mL) and divides by 22.5, and while specific cutoff points may vary slightly between populations and laboratories, the general guideline of less than 1.0 for optimal health is widely accepted.
- If your HOMA-IR is elevated, working with a healthcare provider to develop a personalized plan is recommended, as improvements in HOMA-IR during weight loss may indicate metabolic improvement beneficial for conditions like non-alcoholic fatty liver disease (NAFLD) 1.
Clinical Implications
- HOMA-IR provides a useful surrogate estimate of insulin resistance in persons without diabetes, and its improvement can be a marker of metabolic health enhancement 1.
- Lifestyle modifications and, when necessary, medical interventions aimed at reducing insulin resistance can significantly impact morbidity, mortality, and quality of life by preventing or delaying the onset of type 2 diabetes and other metabolic syndromes.
From the Research
Optimal HOMA-IR Value
The optimal Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) value is not strictly defined, as it can vary depending on the population being studied and the specific criteria used to define insulin resistance. However, several studies have provided insights into the relationship between HOMA-IR values and insulin resistance.
HOMA-IR Cut-off Values
- A study published in 2001 2 established a cut-off value of 3.8 for the HOMA index to diagnose insulin resistance in a non-diabetic population.
- Another study from 2010 3 found that a HOMA-IR value of 2.0 or 2.5 could be used to distinguish non-alcoholic fatty liver disease patients from healthy individuals, with a sensitivity of 85% and specificity of 83% for a value of 2.0, and a sensitivity of 72% and specificity of 94% for a value of 2.5.
- The study from 2001 2 also found that the 90th percentile of the HOMA index in a subgroup of 97 subjects without clinical and biological criteria of insulin resistance was 3.8.
Relationship between HOMA-IR and Insulin Resistance
- The study from 1999 4 found that the log-transformed HOMA-IR correlated more strongly with the insulin resistance index assessed by euglycemic-hyperinsulinemic clamp than did HOMA-IR per se.
- The study from 2001 5 found that HOMA-IR was significantly correlated with the inverse of the glucose infusion rate in both diabetic and non-diabetic subjects, and was more closely associated with the visceral fat area than with the subcutaneous fat area.
- The study from 2016 6 found that HOMA-IR correlated positively with body mass index (BMI) in the entire study group, regardless of which insulin resistance index was used.
Key Findings
- HOMA-IR is a convenient and beneficial method for evaluating insulin resistance, especially in subjects with visceral fat accumulation 5.
- The optimal HOMA-IR value may vary depending on the population being studied and the specific criteria used to define insulin resistance 2, 3.
- HOMA-IR values above or equal to 2.0 or 2.5 may show enhanced diagnostic value in distinguishing non-alcoholic fatty liver disease carriers from control group individuals 3.