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

• Published in: Medicina (Kaunas, Lithuania) Vol. 55; no. 5; p. 158
• Main Authors: Horáková, Dagmar, Štěpánek, Ladislav, Janout, Vladimír, Janoutová, Jana, Pastucha, Dalibor, Kollárová, Helena, Petráková, Alena, Štěpánek, Lubomír, Husár, Roman, Martiník, Karel
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI 17.05.2019; MDPI AG
• Subjects: Adult; Aged; Cholesterol - analysis; Cholesterol - blood; Cross-Sectional Studies; cut-off point; Czech Republic; Female; Glucose - analysis; Glucose Tolerance Test - methods; HOMA-IR; Homeostasis - drug effects; Homeostasis - physiology; Humans; Insulin - analysis; Insulin - blood; insulin resistance; Insulin Resistance - physiology; Logistic Models; Male; Middle Aged; Needs Assessment; Odds Ratio; prediabetes; type 2 diabetes mellitus; Czech Republic; type 2 diabetes mellitus; HOMA-IR; cut-off point; insulin resistance; prediabetes
• ISSN: 1648-9144; 1010-660X; 1648-9144; 1010-660X
• DOI: 10.3390/medicina55050158

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.