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Neither Homeostasis Model Assessment nor Quantitative Insulin Sensitivity Check Index Can Predict Insulin Resistance in Elderly Patients with Poorly Controlled Type 2 Diabetes Mellitus

Third Department of Internal Medicine (A.K., Y.S., H.U., E.C.G., K.M., N.K., T.T., R.A.-S., Y.H., Y.Y., Y.A.) and Departments of Radiology (S.M.) and Laboratory Medicine (K.N.), Mie University School of Medicine, 514-8507 Mie, Japan

Address all correspondence and requests for reprints to: Akira Katsuki, M.D., Third Department of Internal Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu, 514-8507 Mie, Japan. E-mail: katuki-a{at}clin.medic.mie-u.ac.jp.

Abstract

To clarify whether homeostasis model assessment (HOMA IR) and quantitative insulin sensitivity check index (QUICKI) may be indicators of insulin resistance in elderly patients with type 2 diabetes mellitus, their relationship with the glucose infusion rate during the euglycemic hyperinsulinemic clamp study (clamp IR) was assessed. This study comprised 56 Japanese patients with type 2 diabetes mellitus; of these, 28 were 70 yr of age or older (group 1) and 28 were less than 70 yr of age (group 2). Their blood sugars were in poor control (fasting plasma glucose levels: group 1, 9.0 ± 2.6 mmol/liter; group 2, 8.9 ± 2.3 mmol/liter; hemoglobin A1c: group 1, 9.5 ± 2.0%; group 2, 9.2 ± 1.7%).

Log-transformed HOMA IR was significantly correlated with the clamp IR in group 2 patients (r = -0.51, P < 0.01), but not in group 1 patients (r = -0.28, P = 0.15). There was a significant positive correlation between QUICKI and clamp IR in group 2 patients (r = 0.50, P < 0.01). However, no significant correlation was observed between QUICKI and clamp IR in group 1 patients (r = 0.31, P = 0.12). There was a significant correlation between log-transformed HOMA IR (r = -0.37, P < 0.01) or QUICKI (r = 0.37, P < 0.01) and clamp IR when both groups were combined.

In conclusion, neither HOMA IR nor QUICKI should be used as an index of insulin resistance in elderly patients with poorly controlled type 2 diabetes mellitus. The results of this study suggest the need for developing a new noninvasive method for evaluating insulin resistance in those patients.

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