Distribution of HOMA-IR in a population-based cohort and proposal for reference intervals

Bassel Matli; Andreas Schulz; Thomas Koeck; Tanja Falter; Johannes Lotz; Heidi Rossmann; Norbert Pfeiffer; Manfred Beutel; Thomas Münzel; Konstantin Strauch; Philipp S. Wild; Karl J. Lackner

doi:10.1515/cclm-2021-0643

Article

Distribution of HOMA-IR in a population-based cohort and proposal for reference intervals

Bassel Matli , Andreas Schulz , Thomas Koeck , Tanja Falter , Johannes Lotz , Heidi Rossmann , Norbert Pfeiffer , Manfred Beutel , Thomas Münzel , Konstantin Strauch , Philipp S. Wild and Karl J. Lackner

Published/Copyright: August 11, 2021

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From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 59 Issue 11

Abstract

Objectives

Insulin resistance (IR) is a hallmark of type 2 diabetes mellitus (DM). The homeostatic model assessment of insulin resistance (HOMA-IR) provides an estimate for IR from fasting glucose and insulin serum concentrations. The aim of this study was to obtain a reference interval for HOMA-IR for a specific insulin immunoassay.

Methods

The Gutenberg Health Study (GHS) is a population-based, prospective, single-center cohort study in Germany with 15,030 participants aged 35–74 years. Fasting glucose, insulin, and C-peptide were available in 10,340 participants. HOMA-IR was calculated in this group and three reference subgroups with increasingly more stringent inclusion criteria. Age- and sex-dependent distributions of HOMA-IR and reference intervals were obtained. In a substudy three insulin assays were compared and HOMA-IR estimated for each assay.

Results

Among the 10,340 participants analyzed there were 6,590 non-diabetic, 2,901 prediabetic, and 849 diabetic individuals. Median (interquartile range [IQR]) HOMA-IR was 1.54 (1.13/2.19), 2.00 (1.39/2.99), and 4.00 (2.52/6.51), respectively. The most stringently selected reference group consisted of 1,065 persons. Median (IQR) HOMA-IR was 1.09 (0.85/1.42) with no significant difference between men and women. The 97.5th percentile was 2.35. There was a non-significant trend towards higher values with older age. Comparison of three immunoassays for insulin showed an unsatisfactory correlation among the assays and systematic differences in calculated HOMA-IR.

Conclusions

We present HOMA-IR reference intervals for adults derived by more or less stringent selection criteria for the reference cohort. In addition we show that assay specific reference intervals for HOMA-IR are required.

Keywords: diabetes mellitus; HOMA-IR; insulin resistance; metabolic syndrome; method comparison; prediabetes

Corresponding author: Dr. Karl J. Lackner, Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; and DZHK (German Centre for Cardiovascular Research), Partner Site RhineMain, Mainz, Germany, Phone: +49 6131 177190, E-mail: karl.lackner@unimedizin-mainz.de

Funding source: Stiftung Rheinland-Pfalz für Innovation

Award Identifier / Grant number: AZ 961-386261/733

Funding source: Johannes Gutenberg-University of Mainz

Funding source: Boehringer Ingelheim

Funding source: PHILIPS Medical Systems

Funding source: Federal Ministry of Education and Research

Award Identifier / Grant number: BMBF 01EO1503

Funding source: German Center for Cardiovascular Research

Research funding: The Gutenberg Health Study is funded through the government of Rhineland-Palatinate („Stiftung Rheinland-Pfalz für Innovation“, contract AZ 961-386261/733), the research programs “Wissen schafft Zukunft” and “Center for Translational Vascular Biology (CTVB)” of the Johannes Gutenberg-University of Mainz, and its contract with Boehringer Ingelheim and PHILIPS Medical Systems, including an unrestricted grant for the Gutenberg Health Study. P.S. Wild is funded by the Federal Ministry of Education and Research (BMBF 01EO1503). He and T. Münzel are PI of the German Center for Cardiovascular Research (DZHK).
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The study was designed according to the tenets of the revised Helsinki declaration and the study protocol and sampling were approved by the Ethics Commission of the State Chamber of Physicians of Rhineland-Palatinate (reference no. 837.020.07, original vote: 22.3.2007, latest update: 20.10.2015). All participants gave informed written consent to laboratory analyses, clinical examinations, sampling of biomaterial and the use of data records for research purposes.

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Received: 2021-06-01

Accepted: 2021-07-26

Published Online: 2021-08-11

Published in Print: 2021-10-26

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Articles in the same Issue

https://doi.org/10.1515/cclm-2021-0643

Keywords for this article

diabetes mellitus; HOMA-IR; insulin resistance; metabolic syndrome; method comparison; prediabetes