Counterpoint: Appreciating Homeostasis Model Assessment

Estimating insulin sensitivity and beta cell function: perspectives from the modern pandemics of obesity and type 2 diabetes

“…It is a privilege to reflect on the impact of this landmark publication ('Then'), and to place it in the context of the challenges of present day diabetes research and clinical care ('Now'). The paper by Matthews et al and the topic of HOMA in general have been extensively reviewed and discussed by experts in the field over the years [5][6][7][8][9], including Matthews and his colleagues [10], and it is not our purpose here to provide yet another critique or systematic review of HOMA. Instead we will consider the impact of this classic paper in the context of the overlapping modern 'eras' in diabetes research and care that have provided the backdrop to this scientific study (Fig.…”

“…Despite limitations that have been the subject of previous reviews [5][6][7][8][9], HOMA has endured owing to its solid foundations in physiology. In the original study [4], fasting insulin concentrations were measured from three samples over 10 min, thereby taking account of the pulsatility of insulin secretion.…”

“…HOMA was originally devised as a simple mathematical algorithm for quantification of the relative contributions of insulin resistance and beta cell dysfunction to an individual's fasting hyperglycaemia. Given certain limitations [5][6][7][8][9], and despite the relatively small number of individuals studied to derive the 1985 model, HOMA has been widely accepted as a convenient surrogate marker of insulin resistance and beta cell function. To summarise expert critique, HOMA-IR has been well validated against the clamp technique and reflects hepatic more than peripheral insulin resistance, whereas HOMA-%B has been less rigorously evaluated, and is a much less robust estimate of beta cell function [5][6][7][8][9]20].…”

Fetal Programming of Type 2 Diabetes

“…is likely to provide extra information. Another possible explanation for this observation could be that girls may have increased Bcell sensitivity of insulin secretion to circulating glucose and other nutrients (16).…”

Do We Know What Homeostasis Model Assessment Measures?

“…Hockaday et al (2) bring up many points that undermine confidence in HOMA as a measure of insulin resistance. Input into HOMA consists of fasting insulin and glucose concentration and thus will reflect conditions present in the basal state, with the liver as the main target for insulin action as manifested by the suppression of gluconeogenesis.…”