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.
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
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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).
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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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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