American Diabetes Association

Table 2—

Some examples of the use of the HOMA model

Type of study	Glycemic category	Example refs.	Findings
Physiology: comparison of methods	Diabetes IGT Normal	30, 22, 21, 1, 25, 33 25 21, 1, 25, 31, 33	There is good correlation between estimates of IR derived from HOMA and from the euglycemic clamp in normal and diabetic subjects: R_S = 0.88 (P < 0.0001) (1), R_s = 0.85 (P < 0.0001) (21), r = 0.73 (22), and r = 0.73 (30).
			Estimates of β-cell function using HOMA have been shown to correlate well with estimates using CIGMA (R_s = 0.88) (25), hyperglycemic clamps (R_s = 0.61; P < 0.01 [1]; R_s = 0.9, P < 0.001 [33]; r = 0.62, P < 0.005 [31]), and with the acute insulin response from the IVGTT (R_s = 0.63) (25).
Epidemiology: one-off	Diabetes IGT/IFG Normal	34, 35 34, 35 34, 37, 35, 36	In the San Antonio Heart Study, cross-sectional analysis of 2,465 subjects with varying degrees of glucose tolerance showed that Mexican-Americans were significantly more insulin resistant and had higher insulin secretion than non-Hispanic whites at all levels of glucose tolerance (34).
			Matsumoto et al. (35) assessed insulin resistance cross-sectionally in 756 Japanese subjects and showed that subjects with diabetes had significantly increased IR compared with subjects with IGT, but there was no significant difference in IR between subjects with NGT and IGT.
			HOMA has also been used to investigate the relationship between various genetic polymorphisms and insulin resistance in cross-sectional studies (36).
Longitudinal measurement	Diabetes IGT Normal	26, 38 27 27	The UKPDS examined the effects of sulphonylureas, metformin, and diet on %B and %S over 6 years (26). There was an initial increase in %B (from 46 to 78%) at 1 year in subjects on sulphonylureas, followed by a steady decline in function to 52% at 6 years. Subjects on diet only (n = 486) exhibited a gradual decline in β-cell function of about 4% per year. In metformin-treated subjects (n = 159), %S increased from 51 to 62% at 1 year, remaining at 62% at 6 years.
			The Belfast study also examined changes in HOMA-%B and HOMA-%S over a 6-year period in 432 patients with type 2 diabetes on diet only or oral agents (38).
			In the Mexico City Study, %B and %S were measured in 1,449 Mexican subjects with NGT or IGT. After 3.5 years, 4.4% of subjects with NGT and 23.4% with IGT had progressed to diabetes: the development of diabetes was associated with lower %S at baseline (27).
Assess response to treatment	Diabetes	39	Pioglitazone was shown to increase %B and %S compared with placebo in a 23-week study of 197 subjects with type 2 diabetes (39).
Assess risk of developing diabetes	Normal	40	Costa et al. (40) studied 205 first-degree relatives of patients with diabetes, 10.2% were found to have diabetes and 30.7% IGT. %S was reduced in normal subjects with a first-degree relative with type 2 diabetes compared with control subjects (40).
Rodents		41, 42	HOMA has not been validated for animal studies.

Type of study	Glycemic category	Example refs.	Findings
Physiology: comparison of methods	Diabetes IGT Normal	30, 22, 21, 1, 25, 33 25 21, 1, 25, 31, 33	There is good correlation between estimates of IR derived from HOMA and from the euglycemic clamp in normal and diabetic subjects: R_S = 0.88 (P < 0.0001) (1), R_s = 0.85 (P < 0.0001) (21), r = 0.73 (22), and r = 0.73 (30).
			Estimates of β-cell function using HOMA have been shown to correlate well with estimates using CIGMA (R_s = 0.88) (25), hyperglycemic clamps (R_s = 0.61; P < 0.01 [1]; R_s = 0.9, P < 0.001 [33]; r = 0.62, P < 0.005 [31]), and with the acute insulin response from the IVGTT (R_s = 0.63) (25).
Epidemiology: one-off	Diabetes IGT/IFG Normal	34, 35 34, 35 34, 37, 35, 36	In the San Antonio Heart Study, cross-sectional analysis of 2,465 subjects with varying degrees of glucose tolerance showed that Mexican-Americans were significantly more insulin resistant and had higher insulin secretion than non-Hispanic whites at all levels of glucose tolerance (34).
			Matsumoto et al. (35) assessed insulin resistance cross-sectionally in 756 Japanese subjects and showed that subjects with diabetes had significantly increased IR compared with subjects with IGT, but there was no significant difference in IR between subjects with NGT and IGT.
			HOMA has also been used to investigate the relationship between various genetic polymorphisms and insulin resistance in cross-sectional studies (36).
Longitudinal measurement	Diabetes IGT Normal	26, 38 27 27	The UKPDS examined the effects of sulphonylureas, metformin, and diet on %B and %S over 6 years (26). There was an initial increase in %B (from 46 to 78%) at 1 year in subjects on sulphonylureas, followed by a steady decline in function to 52% at 6 years. Subjects on diet only (n = 486) exhibited a gradual decline in β-cell function of about 4% per year. In metformin-treated subjects (n = 159), %S increased from 51 to 62% at 1 year, remaining at 62% at 6 years.
			The Belfast study also examined changes in HOMA-%B and HOMA-%S over a 6-year period in 432 patients with type 2 diabetes on diet only or oral agents (38).
			In the Mexico City Study, %B and %S were measured in 1,449 Mexican subjects with NGT or IGT. After 3.5 years, 4.4% of subjects with NGT and 23.4% with IGT had progressed to diabetes: the development of diabetes was associated with lower %S at baseline (27).
Assess response to treatment	Diabetes	39	Pioglitazone was shown to increase %B and %S compared with placebo in a 23-week study of 197 subjects with type 2 diabetes (39).
Assess risk of developing diabetes	Normal	40	Costa et al. (40) studied 205 first-degree relatives of patients with diabetes, 10.2% were found to have diabetes and 30.7% IGT. %S was reduced in normal subjects with a first-degree relative with type 2 diabetes compared with control subjects (40).
Rodents		41, 42	HOMA has not been validated for animal studies.

IFG, impaired fasting glucose.