HOMA-IR Score Availability in Singapore
Yes, HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) is available in Singapore as it is a calculated index rather than a specific test or device requiring regulatory approval.
What HOMA-IR Is and How It Works
HOMA-IR is a mathematical calculation derived from two standard laboratory measurements that are universally available in Singapore 1:
- Fasting plasma glucose (measured in mmol/L)
- Fasting insulin (measured in mU/ml)
The calculation formula is: (Fasting glucose × Fasting insulin) / 22.5 1
Clinical Utility and Recommendations
HOMA-IR provides a surrogate estimate of insulin resistance in persons without diabetes and can be recommended provided proper reference values have been established 1. The EASL-EASD-EASO guidelines give this an A1 level recommendation 1.
When to Use HOMA-IR:
- Assessment of insulin resistance in non-diabetic individuals - HOMA-IR is most valid when insulin secretion can adapt to insulin resistance 1
- Evaluation of metabolic dysfunction-associated steatotic liver disease (MASLD) - May clarify metabolic dysfunction in adults without established type 2 diabetes 1
- Polycystic ovary syndrome (PCOS) assessment - Used as a metabolic outcome measure in clinical trials and practice 1
- Diagnostic uncertainty cases - Can confirm altered insulin sensitivity in cases like ultrasound-defined steatosis with normal body weight 1
Important Limitations:
- Questionable validity in overt diabetes - The validity depends on the pancreatic beta-cell's ability to adapt to insulin resistance 1
- Assay variability - Insulin measurement assays vary widely between laboratories 1
- No standardized threshold - There is no universal agreement on cut-off values defining insulin resistance using HOMA-IR 1, 2
- Limited diagnostic use for NAFLD - HOMA-IR has limited utility for NAFLD diagnosis in patients with metabolic risk factors (B2 recommendation) 1
Practical Implementation in Singapore
Since HOMA-IR only requires standard laboratory tests (fasting glucose and insulin), any laboratory in Singapore capable of performing these routine assays can provide the necessary data for calculation 3, 4. The calculation itself can be performed manually, through laboratory information systems, or using online calculators 4.
Alternative Approaches:
HbA1c-based estimation - Recent research shows that HOMA-IR can be estimated using HbA1c-derived estimated average glucose (eAG) instead of fasting glucose, which may be more practical for home sampling 3. This correlation is very strong (r² = 0.9972) 3.
Key Clinical Caveats:
- Ensure proper fasting - Patients must be truly fasting for accurate results 4
- Establish local reference values - Cut-off values differ by race, age, gender, and disease state 2
- Use for monitoring - During follow-up, HOMA-IR may help identify patients at risk of NASH or fibrosis progression, and improvement during weight loss may indicate beneficial metabolic changes (C2 recommendation) 1
- Single sample advantage - HOMA-IR requires only a single plasma sample, making it more practical than dynamic testing methods like the euglycemic hyperinsulinemic clamp 1, 4