Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) in the Diagnosis of Insulin Resistance and Prediabetes

Title: Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) in the Diagnosis of Insulin Resistance and Prediabetes

Authors: Dr Deepak Bhosle, Dr Asif Sayyed, Dr Abhijeet Bhagat, Dr Huzaif Sheikh, Dr Vasundhara Londhe

DOI: http://dx.doi.org/10.18535/jmscr/v4i9.65

Abstract

Type 2 diabetes mellitus consists of metabolic disturbances characterised mainly characterized by hyperglycemia which usually result from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. In clinical practice its very difficult to establish how much part of this metabolic disturbances is due to lack of insulin and how much it is due to peripheral resistance to insulin. In many of the cases of type 2 diabetes mellitus metabolic syndrome is present for many years before development of full blown type 2 diabetes mellitus. Metabolic syndrome is a cluster of biochemical and physiological abnormalities associated with the development of cardiovascular disease and type 2 diabetes. Insulin resistance is one of the important determinants of development of metabolic syndrome and then type 2 diabetes mellitus. Insulin resistance is increasing in many parts of the world due to sedentary lifestyle, substance abuse, obesity and harmful food habits. Several methods including estimation of blood glucose and insulin levels during fasting or after oral or intravenous glucose overload, have been used. But due to the simplicity of its determination and calculation, insulin resistance assessment by the homeostatic assay (HOMA-IR) is becoming more popular technique in clinical practice as well as in various epidemiological studies. Unlike type 1 diabetes, type 2 diabetes mellitus is gradual in onset and its diagnosis is usually delayed for many years. Early treatment of hyperglycaemia, hyperlipidemia and other metabolic irregularities reduces the cardiovascular risk in these patients. But these benefits are usually denied to patients mainly due to delay in diagnosis. In fact many of the patients admitted with myocardial infarction are diagnosed with type 2 diabetes while in intensive care units for myocardial infarction. Unlike in type I diabetes mellitus where insulin is deficient consequent to immune mediated destruction of B cells in type 2 diabetes there is Insulin resistance. Insulin resistance in pre diabetic stages can be diagnosed by using various methods. Some simple methods, from which indices can be derived, have been validated. These indices are used depending upon whether they are to be used for epidemiological or clinical purposes. For clinical purposes Quantitative insulin sensitivity check index (QUICKI) and homeostasis model assessment- insulin resistance (HOMA-IR) are most commonly used while for epidemiological purposes indices like Belfiore, Cederholm and Stumvoll index are suitable. This review explains the utility of homeostasis model assessment- insulin resistance (HOMA-IR) for the diagnosis of insulin resistance which is hallmark of pre diabetic state. The purpose of this paper was to review the current information available about HOMA-IR and its use in pre diabetes.

Keywords: Homeostasis model assessment- Insulin resistance (HOMA-IR), Prediabetes, Insulin resistance, Metabolic syndrome.

References

1. Huang PL. A comprehensive definition for metabolic syndrome. Disease Models & Mechanisms. 2009;2(5-6):231-237.

2. Centers for Disease Control and Prevention (US); National Center for Chronic Disease Prevention and Health Promotion (US); Office on Smoking and Health (US). How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2010. 6, Cardiovascular Diseases.

3. Shahraki M, Shahraki T, Shidfar F, Ansari H. Which modifiable, non-modifiable, and socioeconomic factors have more effect on cardiovascular risk factors in overweight and obese women? Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences. 2012;17(7):676-680.

4. Parikh RM, Mohan V. Changing definitions of metabolic syndrome. Indian Journal of Endocrinology and Metabolism. 2012;16(1):7-12.

5. Kim JK. Hyperinsulinemic-euglycemic clamp to assess insulin sensitivity in vivo. Methods Mol Biol. 2009;560:221-38.

6. Gayoso-Diz P, Otero-González A, Rodriguez-Alvarez MX, Gude F, García F, DeFrancisco A, Quintela AG. Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study. BMC Endocr Disord. 2013 Oct 16;13:47.

7. Gutch M, Kumar S, Razi SM, Gupta KK, Gupta A. Assessment of insulin sensitivity /resistance. Indian Journal of Endocrin-ology and Metabolism2015;19(1):160-164.

8. DeUgarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in thepolycystic ovary syndrome using the homeostasis model assessment. Fertil Steril. 2005 May;83(5):1454-60.

9. Turner R.C., Holman R.R., Hockaday T.D.R.Beta Cell Deficiency in maturity onset diabetesMedical Research Society 1976 meeting.

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

11. Manley SE, Luzio SD, Stratton IM, Wallace TM, Clark PMS. Preanalytical, Analytical, and Computational Factors Affect Homeostasis Model Assessment Estimates . Diabetes Care. 2008;31(9): 1877-1883.

12. Salgado AL, Carvalho Ld, Oliveira AC, Santos VN, Vieira JG, Parise ER. Insulinresistance index (HOMA-IR) in the differentiation of patients with non-alcoholic fatty liver disease and healthy individuals. Arq Gastroenterol. 201Apr-Jun;47 (2):165-9.

13. Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu M, Kendirici M, Keskin M, Kondolot M. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol.2010;2(3):100-6.

14. Sung CC, Liao MT, Lu KC, Wu CC. Role of vitamin D in insulin resistance. J Biomed Biotechnol. 2012;2012:634195.

15. Bonora E, Formentini G, Calcaterra F, Lombardi S, Marini F, Zenari L, SaggianiF, Poli M, Perbellini S, Raffaelli A, Cacciatori V, Santi L, Targher G, BonadonnaR, Muggeo M. HOMA-estima-ted insulin resistance is an indepen-dent predictor of cardiovascular disease in type 2 diabetic subjects: prospective data from theVerona Diabetes Complications Study. Diabetes Care. 2002 Jul;25(7): 1135-41.

16. Chang AM, Smith MJ, Bloem CJ, Galecki AT, Halter JB, Supiano MA. Limitation ofthe homeostasis model assessment to predict insulin resistance and beta-celldysfunction in older people. J Clin Endocrinol Metab. 2006 Feb;91(2):629-34. Epub2005 Nov 29.

17. Singh Y, Garg MK, Tandon N, Marwaha RK. A study of insulin resistance byHOMA-IR and its cut-off value to identify metabolic syndrome in urban Indianadolescents. J Clin Res Pediatr Endocrinol. 2013;5(4):245-51.

18. Srinivasan MP, Kamath PK, Bhat NM, Pai ND, Manjrekar PA, Mahabala C. Factors associated with no apparent coronary artery disease in patients with type 2 diabetes mellitus for more than 10 years of duration: a case control study. Cardiovas-cular Diabetology. 2015;14:146.

19. Qu H-Q, Li Q, Rentfro AR, Fisher-Hoch SP, McCormick JB. The Definition of Insulin Resistance Using HOMA-IR for Americans of Mexican Descent Using Machine Learning. Vella A, ed. PLoS ONE. 2011;6(6):e21041. doi:10.1371/ journal.pone.0021041.

20. Kang ES, Yun YS, Park SW, Kim HJ, Ahn CW, Song YD, Cha BS, Lim SK, Kim KR, LeHC. Limitation of the validity of the homeostasis model assessment as an index of insulin resistance in Korea. Metabolism. 2005 Feb;54(2):206-11.

Corresponding Author

Dr Asif Sayyed

Chief Resident, Dept of Pharmacology

M.G.M’S Medical College Aurangabad (MS)-India