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Limitation of the Homeostasis Model Assessment to Predict Insulin Resistance and ß-Cell Dysfunction in Older People

Department of Internal Medicine (A.M.C., M.A.S.) and Geriatric Research, Education, and Clinical Center (M.A.S.), Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan 48105; and Department of Internal Medicine (A.M.C., M.J.S., C.J.B., A.T.G., J.B.H., M.A.S.), University of Michigan, Ann Arbor, Michigan 49109

Address all correspondence and requests for reprints to: Annette M. Chang, M.D., University of Michigan, 5570 MSRB II, 1150 West Medical Center Drive, Ann Arbor, Michigan 48109-0678. E-mail: annchang{at}umich.edu.

Context: Studies in older people have shown inconsistent agreement between homeostasis model assessment of insulin resistance (HOMA-IR) and dynamic measures of insulin action and have not evaluated HOMA ß-cell.

Objective: We compared measures of insulin sensitivity and ß-cell function from the frequently sampled iv glucose tolerance test (FSIGT) to HOMA models.

Design/Patients/Setting/Intervention: Two hundred fourteen young and old with normal glucose tolerance (NGT) and old with impaired glucose tolerance (IGT) participated in a retrospective analysis of FSIGT data in a university medical setting.

Main Outcome Measure: Sensitivity to insulin (S_I) and acute insulin response to glucose (AIRg) from FSIGT were compared with HOMA models.

Results: S_I and HOMA-IR measures identified similar patterns of increasing insulin resistance in the two older groups, compared with younger people with NGT, with the greatest degree of insulin resistance in older people with IGT (P < 0.05 vs. young and old NGT for both S_I and HOMA-IR). Agreement between HOMA-IR and S_I was moderate (weighted kappa = 0.51). AIRg was similar in young and old NGT but was markedly decreased in old IGT (P < 0.05 vs. young and old NGT). HOMA-ß-cell was similar in the three groups. Agreement between HOMA ß-cell and AIRg was weak (weighted kappa = 0.35).

Conclusions: HOMA-IR may detect age-related insulin resistance when comparing large populations of older people. However, dynamic testing appears to be necessary to quantitate diminished insulin secretion in older people.

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