Homeostasis Model Assessment (HOMA) as Surrogate Insulinization Criteria in Patients With Type 2 Diabetes

Abstract

Type 2 diabetes mellitus is a metabolic disorder that results from defects in both insulin secretion and insulin action. Questions remain about when insulin therapy is indicated; thus, the aim of this study was to evaluate homeostasis model assessment beta-cell (HOMAbetacell) values as surrogate criteria for insulin therapy indication in patients with type 2 diabetes. A prospective study was performed involving 189 type 2 diabetic patients with deficient metabolic control assessed by clinical and laboratory parameters. All patients received nutritional intervention and combination therapy with metformin and glimepiride. Patients who did not respond were admitted to the next phase, which consisted of glimepiride + metformin + rosiglitazone oral therapy and revaluation after 3 months. Comparisons between responders and nonresponders in this phase were made in order to achieve differences in metabolic parameters and beta cell function. Of 189 patients studied, 150 (79.36%) were considered full responders in the first phase of this study. The remaining 39 patients were admitted in the second trial phase, in which 20 patients (51.28%) responded to triple oral therapy, while the other 19 (49.72%) required insulin therapy. Significant differences were found in fasting and postprandial glycemia (P < 0.001; P < 0.004) between the non-insulin-requiring group (200 +/- 12.0 mg/dL; 266.05 +/- 17,67 mg/dL) and the insulin-requiring group (291.5 +/- 17.6 mg/dL; 361.6 +/- 26.1 mg/dL). Likewise, significant differences were observed in homeostasis model assessment insulin resistance (HOMAIR) and HOMAbetacell values (P < 0.002; P < 0.04) between non-insulin-requiring patients (7.7 +/- 0.8; 24.5 +/- 1.3%) and insulin-requiring patients (12.6 +/- 1.2; 19.4 +/- 2.4%). Finally, significant differences were observed when comparing body mass index (non-insulin-requiring group, 29.2 +/- 0.4 kg/m, versus insulin-requiring group, 27.1 +/- 0.9 kg/m; P < 0.05). HOMAbetacell determination in clinical practice is a useful tool to determine when insulin therapy should be started for type 2 diabetic patients.

Comparison of Exenatide and Metformin Monotherapy in Overweight/Obese Patients with Newly Diagnosed Type 2 Diabetes

“…BMI was calculated as weight (kg)/height (m 2 ). HOMA of insulin resistance (HOMA-IR) and homeostasis model assessment of β -cell function (HOMA- β ) have been computed according to the following formulas: HOMA-IR = FINS ( μ IU/mL) × FBG (mmol/L)/22.5 and HOMA- β = 20 × FINS ( μ IU/mL)/FBG (mmol/L) − 3.5 [ 8 ].…”

MARCH2: Comparative Assessment of Therapeutic Effects of Acarbose and Metformin in Newly Diagnosed Type 2 Diabetes Patients

“…The optimal levels of LDL-C and non-HDL-C were defined as: LDL-C<100 mg/dL (2.6 mmol/L) and non-HDL-C<130 mg/dL (2.6 mmol/L) [8]. We calculated homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of β cell function (HOMA-β) by using the following equation: HOMA-IR  =  [FBG (mmol/L)* FINS (mIU/L) /22.5]; HOMA-β = 20*FINS (mIU/L) / [FBG (mmol/L) - 3.5] [9]–[10]. According to BMI value, these subjects were divided into three groups: normal weight group (<24 kg/m 2 ), overweight group (24–28 kg/m 2 ) and obese group (≥28 kg/m 2 ) [11].…”

Involvement of Insulin Resistance in the Protective Effect of Metformin Against Alcoholic Liver Injury

“…The index of insulin resistance was calculated using the following equation: Insulin resistance index (Homa-IR) = Serum fasting glucose (mM) 9 Serum fasting insulin (mU/l)/22.5 (Bermudez et al, 2008). Fasting serum insulin was measured by ELISA kit performed according to the manufacturer's instructions (Santa Cruz Biotechnology Inc.).…”

“…Fasting serum insulin was measured by ELISA kit performed according to the manufacturer's instructions (Santa Cruz Biotechnology Inc.). The index of insulin resistance was calculated using the following equation: Insulin resistance index (Homa-IR) = Serum fasting glucose (mM) 9 Serum fasting insulin (mU/l)/22.5 (Bermudez et al, 2008). Serum adiponectin was determined using commercial ELISA kits from R&D Systems, Inc. (Minneapolis, MN).…”