The threshold value for identifying insulin resistance (HOMA-IR) in an admixed adolescent population: A hyperglycemic clamp validated study

Abstract

Objectives:To validate the homeostasis model assessment (HOMA) of insulin resistance (IR) as a surrogate to the hyperglycemic clamp to measure IR in both pubertal and postpubertal adolescents, and determine the HOMA-IR cutoff values for detecting IR in both pubertal stages. Subjects and methods: The study sample comprised 80 adolescents of both sexes (aged 10-18 years; 37 pubertal), in which IR was assessed with the HOMA-IR and the hyperglycemic clamp. Results: In the multivariable linear regression analysis, adjusted for sex, age, and waist circumference, the HOMA-IR was independently and negatively associated with the clamp-derived insulin sensitivity index in both pubertal (unstandardized coefficient -B = −0.087, 95% confidence interval [CI] = −0.135 to −0.040) and postpubertal (B = −0.101, 95% CI, −0.145 to −0.058) adolescents. Bland-Altman plots showed agreement between the predicted insulin sensitivity index and measured clamp-derived insulin sensitivity index in both pubertal stages (mean = −0.00 for pubertal and postpubertal); all P > 0.05. The HOMA-IR showed a good discriminatory power for detecting IR with an area under the receiver operator characteristic curve of 0.870 (95% CI, 0.718-0.957) in pubertal and 0.861 (95% CI, 0.721-0.947) in postpubertal adolescents; all P < 0.001. The optimal cutoff values of the HOMA-IR for detecting IR were > 3.

High prevalence of low high‐density lipoprotein cholesterol and insulin resistance among children and adolescents living with HIV in Uganda: harbinger for metabolic syndrome?

“…The homeostatic model assessment of insulin resistance (HOMA‐IR) was calculated as the product of insulin (μU/L) and glucose (mmol/L) divided by 22.5 [35]. There is no clear consensus for the cut‐off values of HOMA to define IR in children and adolescents [36], but we used two approaches to corroborate our findings: (1) common in the literature within 10–15 years, IR was defined as HOMA‐IR >2.5 for prepubertal children (Tanner stage 1 [37])and >4.0 for pubertal stages (Tanner stage >1), and (2) most recent years and based on validation using hyperglycaemic clamp, >3.22 for pubertal and >2.91 for post‐pubertal adolescents [38].…”

Association of physical activity and sitting with metabolic syndrome and hyperglycemic clamp parameters in adolescents – BRAMS pediatric study

“…First, the detailed assessment of metabolic parameters in a large sample of adolescents is rarely found in the literature and allows further investigations on the association of lifestyle and sensitive markers of metabolic disorders, which was extended to a subsample of individuals who participated in the hyperglycemic clamp protocol, a gold standard for insulin secretion evaluation, and a direct measurement of insulin sensitivity (28). Statistical correction for pubertal status and sleep was an important asset, as these factors are well-known confounders, as shown by previous studies with the BRAMS-P dataset using the hyperglycemic clamp protocol (30,39). Another advantage of the present study was to use the time spent sitting and time spent on moderate-to high-intensity physical activity as confounding factors of each other's exposure, which favors the interpretation of the results.…”