Increased HOMA-IR is a significant risk factor for the presence of type 2 diabetes mellitus (OR 1.2; 95% CI 1.14-1.28; p<0.0001), with an optimal diagnostic cut-off of 3.63.
Cross-Sectional (n=3,539)
What are the optimal HOMA-IR cut-offs for diagnosing prediabetes and type 2 diabetes in the Czech population?
Establishing HOMA-IR cut-offs of 1.82 for prediabetes and 3.63 for T2DM in the Czech population may aid in early identification of insulin resistance in clinical practice.
Odds Ratio: 1.2 (95% CI 1.14–1.28)
p-value: p=<0.0001
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.
Horáková et al. (2019) conducted a cross-sectional in Insulin resistance and Type 2 diabetes mellitus (n=3,539). Increased HOMA-IR score was evaluated on Presence of T2DM (OR 1.2, 95% CI 1.14-1.28, p=<0.0001). Increased HOMA-IR is a significant risk factor for the presence of type 2 diabetes mellitus (OR 1.2; 95% CI 1.14-1.28; p<0.0001), with an optimal diagnostic cut-off of 3.63.