Optimal Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) Cut-Offs: A Cross-Sectional Study in the Czech Population

Abstract

Background and Objectives: The key pathogenetic mechanism of glucose metabolism disorders, insulin resistance (IR), can be assessed using the Homeostasis Model Assessment of IR (HOMA-IR). However, its application in clinical practice is limited due to the absence of cut-offs. In this study, we aimed to define the cut-offs for the Czech population. Methods: After undergoing anthropometric and biochemical studies, the sample of 3539 individuals was divided into either nondiabetics, including both subjects with normal glucose tolerance (NGT, n = 1947) and prediabetics (n = 1459), or diabetics (n = 133). The optimal HOMA-IR cut-offs between subgroups were determined to maximize the sum of the sensitivity and specificity for diagnosing type 2 diabetes mellitus (T2DM) or prediabetes. The predictive accuracy was illustrated using receiver operating characteristic (ROC) curves. Logistic regression was performed to assess the association between a target variable (presence/absence of T2DM) depending on the HOMA-IR score as well as on the age and sex. Results: The HOMA-IR cut-off between nondiabetics and diabetics for both sexes together was 3.63, with a sensitivity of 0.56 and a specificity of 0.86. The area under the ROC curve was 0.73 for T2DM diagnosing in both sexes. The HOMA-IR cut-off between the NGT subjects and prediabetics was 1.82, with a sensitivity of 0.60 and a specificity of 0.66. Logistic regression showed that increased HOMA-IR is a risk factor for the presence of T2DM (odds ratio (OR) 1.2, 95% confidence interval (CI) 1.14–1.28, p < 0.0001). The predictive ability of HOMA-IR in diagnosing T2DM is statistically significantly lower in females (OR 0.66, 95% CI 0.44–0.98). The results are valid for middle-aged European adults. Conclusions: The results suggest the existence of HOMA-IR cut-offs signaling established IR. Introduction of the instrument into common clinical practice, together with the known cut-offs, may contribute to preventing T2DM.

Insulin Resistance in Association with Thyroid Function, Psychoemotional State, and Cardiovascular Risk Factors

“…Although IR is usually defined as a value greater than the 75th percentile value for non-diabetic subjects, the cut-off values reported in the literature vary widely [61]. The results from the present study are very similar to those reported in a study defining HOMA-IR cut-offs for middle-aged men and women in the Czech Republic [62]. In a crosssectional study of Chinese people, Lee et al [63] derived an optimal HOMA-IR cut-off of 2.0 to discriminate nondiabetics from diabetics.…”

Alterations of glycaemia, insulin resistance and body mass index within the C-peptide optimal range in non-diabetic patients

“…However, the mean level of insulin (9.1 mIU/l) is similar to that in the group with a C-peptide range of 711-950 pmol/l (9.00 mIU/l). Similarly, the range of BMI values seems to be wider (from 28.3 to 37.4 kg/m 2 ) but approaching that in Czech patients without diabetes in the year 2018 (from 32.8 to 33.3 kg/m 2 ) (Horáková et al, 2019). Andrade et al (2018) also came to similar conclusions regarding glycaemia changes in healthy individuals divided by the quartiles of C-peptide.…”

“…Insulin resistance was assessed by the HOMA IR score (Homeostasis Model Assessment for Insulin Resistance) based on insulin and glucose concentrations. HOMA IR cut-off was set at 3.63, considered a signal of glucose metabolism alterations within the Czech population (Horáková et al, 2019). A body mass index (BMI) reference range of 20.0-24.9 kg/m 2 (normal weight) was calculated by Svačina and Bretšnajdrová (2003).…”

The Interactive Effect of High Doses of Chromium(III) and Different Iron(III) Levels on the Carbohydrate Status, Lipid Profile, and Selected Biochemical Parameters in Female Wistar Rats

“…The serum insulin, ghrelin, and leptin concentrations were measured with ELISA kits (EZRMI-13K and EZRL-83K, Millipore Corporation, Burlington, MA, USA; EZRGRT-91K, Linco Research, St Charles, MO, USA). The homeostatic model assessment for insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI) were calculated in accordance with the standard formulas from fasting plasma glucose and insulin [ 47 , 48 , 49 ].…”