Insulin Resistance and HOMA - interesting link

[LittleGreyCat]

I had an IR test a while back and looking at the calculations, noted that it used HOMA.

I also noticed that HOMA can be used to calculate insulin resistance and also ß cell function.

I asked why they only supplied an IR estimate, and was sent this link:
http://care.diabetesjournals.org/content/27/6/1487 "
Use and Abuse of HOMA Modeling
"
Hmmm...abuse.

"We review the use and reporting of HOMA in the literature and give guidance on its appropriate use (e.g., cohort and epidemiological studies) and inappropriate use (e.g., measuring β-cell function in isolation).".

Well, that's me told!

Anyway, looks a useful read.

 

[AloeSvea]

Goodness! Use and abuse? Gracious me! That's telling us for sure.

I have worked out my B-cell function too by doing the maths with C-peptide readings, and been very open and honest to my medical centre about what I was doing. So yeah - trying to measure my B-cell function in isolation indeed! And I am appalled that it isn't a standard thing measured for T2 diabetes because I found the information so useful.

I wrote my medical centre a nice little email telling them I was really grateful for my C-peptide results over time since diagnosis (I got them a couple of years later) as it gave me a huge insight into the workings of my poor ol' diabetic body (that kind of thing). I found it HUGELY helpful in terms of seeing how resistant to insulin my cells are, so as I know (I think!) that I produce now normal levels of insulin (high end normal, but still in the range) that I have very resistant insulin resistance. I couldn't know this without doing that computation. And what's more it fits well with the results of my experimentations with my blood glucose levels etc.

I didn't get a reply, of course. And the conventional medical profession (and insurance underwriters!) wonders why, I would bother I am sure, when all they look at is my HBA1c and my cholesterol levels. But I believe it is good to have these things on record in the files of T2 diabetics treating with diet and activity.

But we know - right? And we are what really matters. Especially when we are on the front line for trying to get better with this blasted blood glucose/insulin dysregulation.

 

[AloeSvea]

My partner and I went on and read the original article, and searched high and low for the abuse. How did the ADA go from assuring clarity to abuse? Hmmmm

"CONCLUSIONS
The HOMA model has proved be a robust clinical and epidemiological tool in descriptions of the pathophysiology of diabetes. Already quoted in >500 publications, it has become one of the standard tools in the armamentarium of the clinical physiologist.

HOMA analysis allows assessment of inherent β-cell function and insulin sensitivity and can characterize the pathophysiology in those with abnormal glucose tolerance. Longitudinal data in normal subjects who go on to develop abnormal glucose tolerance is particularly informative. The use of HOMA to make comparisons across ethnic groups is valid, but the baseline HOMA-%S from a normoglycemic population in each comparative group should be established first in order to determine whether a difference in insulin sensitivity between groups simply reflects a different baseline.

Although longitudinal changes in HOMA-%B in subjects on insulin secretagogues can be useful in determining β-cell function over time, it must be remembered that any initial increase in HOMA-%B following initiation of treatment simply reflects the mechanism of action of the drug. β-Cell function cannot be interpreted in the absence of a measure of insulin sensitivity, and therefore HOMA-%S should always be reported alongside HOMA-%B. The use of HOMA to assess insulin sensitivity in subjects treated with insulin has many potential problems and needs further validation.

Clarity is needed in reporting HOMA due to the problems of describing changes in percentages. HOMA values are rarely normally distributed and should therefore be logarithmically transformed and reported as geometric means with appropriate measures of dispersion. When used appropriately, HOMA can yield valuable data, but as is common with all models, the primary input data need to be robust and the data should be interpreted carefully."