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Vol 2, No 4 (2001): Practical Diabetology
Original articles (translated)
Published online: 2001-11-19
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Limited value of the homeostasis model assessment to predict insulin resistance in older men with impaired glucose tolerance

Cynthia M. Ferrara, Adrew P. Goldberg
Diabetologia Praktyczna 2001;2(4):299-306.

open access

Vol 2, No 4 (2001): Practical Diabetology
Original articles (translated)
Published online: 2001-11-19

Abstract

INTRODUCTION. Insulin resistance (IR) in older individuals is associated with risk factors for coronary artery disease. The glucose clamp measures IR directly, but the homeostasis model assessment (HOMA) of IR, referred to here as HOMA-IR, is based on fasting glucose and insulin and is less invasive and labor intensive. This method requires validation in the elderly.
MATERIAL AND METHODS. We assessed the validity of HOMA-IR as an index of IR by comparing it to glucose infusion rates (GIRs) measured by a glucose clamp (600 pmol x m-2 x min-1) in 45 obese men (61 ± 8 years of age, mean ± SD) with normal glucose tolerance (NGT) (n = 21) or impaired glucose tolerance (IGT) (n = 24). We also evaluated relationships between body composition, exercise capacity, and IR.
RESULTS. Subjects with NGT had lower BMI (28 ± 3 vs. 31 ± 3 kg/m2), waist circumference (97 ± 9 vs. 105 ± ± 9 cm), waist-to-hip ratio (WHR) (0.93 ± 0.06 vs. 0.97 ± 0.05), and percent body fat (25 ± 6 vs. 30 ± ± 6) than subjects with IGT. Subjects with NGT also had lower areas above basal during the 2-h oral glucose tolerance test for glucose (274 ± 95 vs. 419 ± ± 124 mmol x min/l) and insulin (38.142 ± 18.206 vs. 58.383 ± 34.408 pmol x min/l) and lower HOMA-IR values (2.2 ± 0.8 vs. 4.2 ± 2.6) than subjects with IGT. GIR (mmol x kg-1 FFM x min-1) was higher in subjects with NGT than in subjects with IGT (53 ± 11 vs. 43 ± 14). HOMA-IR correlated with GIR in subjects with NGT (r = –0.59), but not in subjects with IGT (r = –0.13). GIR correlated with VO2max in subjects with NGT (r = 0.58) and IGT (r = 0.42), but with WHR only in subjects with NGT (r = –0.53). HOMA-IR correlated with VO2max (r = –0,57) and waist circumference (r = 0.54) in subjects with NGT, but with percent body fat in subjects witch IGT (r = 0.54).
CONCLUSIONS. These findings indicate that HOMA- -IR should not be used as an index of IR in older individuals who may be at risk for IGT, and suggest that lifestyle changes that increase VO2max and decrease body fat may reduce IR in older people.

Abstract

INTRODUCTION. Insulin resistance (IR) in older individuals is associated with risk factors for coronary artery disease. The glucose clamp measures IR directly, but the homeostasis model assessment (HOMA) of IR, referred to here as HOMA-IR, is based on fasting glucose and insulin and is less invasive and labor intensive. This method requires validation in the elderly.
MATERIAL AND METHODS. We assessed the validity of HOMA-IR as an index of IR by comparing it to glucose infusion rates (GIRs) measured by a glucose clamp (600 pmol x m-2 x min-1) in 45 obese men (61 ± 8 years of age, mean ± SD) with normal glucose tolerance (NGT) (n = 21) or impaired glucose tolerance (IGT) (n = 24). We also evaluated relationships between body composition, exercise capacity, and IR.
RESULTS. Subjects with NGT had lower BMI (28 ± 3 vs. 31 ± 3 kg/m2), waist circumference (97 ± 9 vs. 105 ± ± 9 cm), waist-to-hip ratio (WHR) (0.93 ± 0.06 vs. 0.97 ± 0.05), and percent body fat (25 ± 6 vs. 30 ± ± 6) than subjects with IGT. Subjects with NGT also had lower areas above basal during the 2-h oral glucose tolerance test for glucose (274 ± 95 vs. 419 ± ± 124 mmol x min/l) and insulin (38.142 ± 18.206 vs. 58.383 ± 34.408 pmol x min/l) and lower HOMA-IR values (2.2 ± 0.8 vs. 4.2 ± 2.6) than subjects with IGT. GIR (mmol x kg-1 FFM x min-1) was higher in subjects with NGT than in subjects with IGT (53 ± 11 vs. 43 ± 14). HOMA-IR correlated with GIR in subjects with NGT (r = –0.59), but not in subjects with IGT (r = –0.13). GIR correlated with VO2max in subjects with NGT (r = 0.58) and IGT (r = 0.42), but with WHR only in subjects with NGT (r = –0.53). HOMA-IR correlated with VO2max (r = –0,57) and waist circumference (r = 0.54) in subjects with NGT, but with percent body fat in subjects witch IGT (r = 0.54).
CONCLUSIONS. These findings indicate that HOMA- -IR should not be used as an index of IR in older individuals who may be at risk for IGT, and suggest that lifestyle changes that increase VO2max and decrease body fat may reduce IR in older people.
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Keywords

homeostasis model assessment; impaired glucose tolerance; insulin resistance

About this article
Title

Limited value of the homeostasis model assessment to predict insulin resistance in older men with impaired glucose tolerance

Journal

Clinical Diabetology

Issue

Vol 2, No 4 (2001): Practical Diabetology

Pages

299-306

Published online

2001-11-19

Bibliographic record

Diabetologia Praktyczna 2001;2(4):299-306.

Keywords

homeostasis model assessment
impaired glucose tolerance
insulin resistance

Authors

Cynthia M. Ferrara
Adrew P. Goldberg

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