HOMA-IR (Homeostatic Model Assessment for Insulin Resistance)
Patients evaluated for potentially impaired glucose tolerance and diabetes.
The score, a shortcut for estimating insulin resistance (IR), has been examined in multiple studies. Results typically show reasonable correlation between HOMA-IR and ‘clamp’ measurement, the gold standard. However agreement levels between the two, a more important gauge for individual accuracy and clinical use, are weak, suggesting more research and refinement are needed for clinical use.
Clamp methods for measuring IR are resource intensive, invasive and time consuming, and IR can be a useful metric. An estimate of IR may help decision making.
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The HOMA-IR score may be most useful for epidemiologic, population-based, and other group level assessments. In addition, optimal diagnostic cutoffs for IR-related conditions seem to vary considerably from one population or group to the next so care should be taken to customize cutoffs when using the score.
We are unaware of validated management algorithms using the HOMA-IR score.
The HOMA-IR score should not be used in patients on insulin, and studies have questioned its accuracy in those with impaired glucose tolerance, normal BMI, the elderly, and others.
- Score = (Fasting insulin)*(Fasting glucose) / 405
- NOTE: Scores are calculated in mg/dL.
Facts & Figures
The HOMA-IR is used to measure severity of insulin resistance, though normal insulin resistance varies depending on the population. Common reference levels for HOMA-IR insulin resistance range from 0.7 - 2.
Original/Primary ReferenceMatthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985 Jul;28(7):412-9.
ValidationHermans MP, Levy JC, Morris RJ, Turner RC. Comparison of tests of beta-cell function across a range of glucose tolerance from normal to diabetes. Diabetes September 1999 48:9 1779-1786; doi:10.2337/diabetes.48.9.1779
Other ReferencesSalgado AL, Carvalho Ld, Oliveira AC, Santos VN, Vieira JG, Parise ER. Insulin resistance index (HOMA-IR) in the differentiation of patients with non-alcoholic fatty liver disease and healthy individuals. Arq Gastroenterol. 2010 Apr-Jun;47(2):165-9.Tohidi M, Ghasemi A, Hadaegh F, Derakhshan A, Chary A, Azizi F. Clin Biochem. Age- and sex-specific reference values for fasting serum insulin levels and insulin resistance/sensitivity indices in healthy Iranian adults: Tehran Lipid and Glucose Study. 2014 Apr;47(6):432-8. doi: 10.1016/j.clinbiochem.2014.02.007. Epub 2014 Feb 14.
About the Creator
David R. Matthews, MD, is a Professor of Diabetic Medicine at the University of Oxford. He is the Deputy co-ordinator and member of the Executive and Policy Advisory Committees of the UK Prospective Study of Diabetes (UKPDS), as well as the founder of the Oxford Health Alliance. He is currently investigating the inter-relationships between insulin resistance and beta cell function, and the effects of a low carbohydrate diet in people with and without type 2 diabetes at Churchill Hospital with the Center of Diabetes, in the United Kingdom.
To view Dr. David R. Matthews's publications, visit PubMed