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

• Published in: Archives of Endocrinology and Metabolism Vol. 67; no. 1; pp. 119 - 125
• Main Authors: Silva, Cleliani de Cassia da, Zambon, Mariana Porto, Vasques, Ana Carolina Junqueira, Camilo, Daniella Fernandes, Antonio, Maria Ângela Reis de Góes Monteiro, Geloneze, Bruno
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Endocrinologia e Metabologia 18.01.2023; Brazilian Society of Endocrinology and Metabolism
• Subjects: Adolescent; adolescents; Blood Glucose - analysis; Body Mass Index; Female; glucose clamp technique; Homeostasis; Homeostasis model assessment; Humans; Insulin; Insulin Resistance; Male; Original; Regression Analysis; Waist Circumference; glucose clamp technique; adolescents; Homeostasis model assessment; insulin resistance
• ISSN: 2359-3997; 2359-4292
• DOI: 10.20945/2359-3997000000533

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. 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. 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 > 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 < 0.001. The optimal cutoff values of the HOMA-IR for detecting IR were > 3.22 (sensitivity, 85.7; 95% CI, 57.2-98.2; specificity, 82.6; 95% CI, 61.2-95.0) for pubertal and > 2.91 (sensitivity, 63.6; 95% CI, 30.8-89.1, specificity, 93.7; 95%CI, 79.2-99.2) for postpubertal adolescents. The threshold value of the HOMA-IR for identifying insulin resistance was > 3.22 for pubertal and > 2.91 for postpubertal adolescents.