Optimal Cut-Offs of Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) to Identify Dysglycemia and Type 2 Diabetes Mellitus: A 15-Year Prospective Study in Chinese

Abstract

BackgroundThe optimal reference range of homeostasis model assessment of insulin resistance (HOMA-IR) in normal Chinese population has not been clearly defined. Here we address this issue using the Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS), a prospective population-based cohort study with long-term follow-up.Material & MethodsIn this study, normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM) were defined according to the 1998 World Health Organization criteria. Dysglycemia referred to IFG, IGT or T2DM. This study comprised two parts. Part one was a cross-sectional study involving 2,649 Hong Kong Chinese subjects, aged 25–74 years, at baseline CRISPS-1 (1995–1996). The optimal HOMA-IR cut-offs for dysglycemia and T2DM were determined by the receiver-operating characteristic (ROC) curve. Part two was a prospective study involving 872 subjects who had persistent NGT at CRISPS-4 (2010–2012) after 15 years of follow-up.ResultsAt baseline, the optimal HOMA-IR cut-offs to identify dysglyceia and T2DM were 1.37 (AUC = 0.735; 95% confidence interval [CI] = 0.713–0.758; Sensitivity [Se] = 65.6%, Specificity [Sp] = 71.3%] and 1.97 (AUC = 0.807; 95% CI = 0.777–0.886; Se = 65.5%, Sp = 82.9%) respectively. These cut-offs, derived from the cross-sectional study at baseline, corresponded closely to the 75th (1.44) and 90th (2.03) percentiles, respectively, of the HOMA-IR reference range derived from the prospective study of subjects with persistent NGT.ConclusionsHOMA-IR cut-offs, of 1.4 and 2.0, which discriminated dysglycemia and T2DM respectively from NGT in Southern Chinese, can be usefully employed as references in clinical research involving the assessment of insulin resistance.

MACK‐3 (combination of hoMa, Ast and CK18): A promising novel biomarker for fibrotic non‐alcoholic steatohepatitis

“…However, diagnostic studies using liver biopsy as the gold standard are not feasible in the community. Secondly, this study was conducted on a Malaysian population and may not be generalizable to other populations, especially since HOMA may vary between different populations . Nevertheless, the results from our study does not differ significantly from that by Boursier et al, suggesting that HOMA estimations do not influence the accuracy of the test.…”

Adipocyte-secreted exosomal microRNA-34a inhibits M2 macrophage polarization to promote obesity-induced adipose inflammation

“…Pearson correlation analysis showed that the homeostasis model assessment of insulin resistance (HOMA-IR) was positively associated with miR-34a abundance in visceral fat ( Figure 7F; r = 0.3403, P < 0.05), but negatively correlated with KLF4 mRNA levels in the adipose tissue ( Figure 7G; r = -0.3565, P < 0.05). Furthermore, when the overweight/obese subjects were classified into insulin-sensitive (HOMA-IR < 1, n = 8) and insulinresistant groups (HOMA-IR > 1, n = 16) according to the optimal cutoff value determined in our 15-year prospective study (37), the insulin-sensitive subjects exhibited a lower level of miR-34a than those with a higher HOMA-IR value (0.89 ± 0.24 vs. 1.87 ± 0.22, P < 0.05).…”

METS-IR, a novel score to evaluate insulin sensitivity, is predictive of visceral adiposity and incident type 2 diabetes

“…IR is known to increase the risk for the development of dyslipidemia, hypertension, coronary artery disease and, particularly T2D (35,36). Fasting IR indexes, including QUICKI, HOMA-IR, TyG index and the TG/HDL ratio have all been shown to predict incident T2D (37,38,39,40). In our study, individuals in the highest percentile of METS-IR score had a 3.9-fold increase in the risk of incident T2D after follow-up, compared to the lowest METS-IR quartile.…”