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This version published online on November 29, 2005
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2005-1803
A more recent version of this article appeared on February 1, 2006
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*Compound via MeSH
*Substance via MeSH

Submitted on August 10, 2005
Accepted on November 22, 2005

Limitation of the Homeostasis Model Assessment to Predict Insulin Resistance and {beta}-cell Dysfunction in Older People

Annette M. Chang*, Marla J. Smith, Cathie J. Bloem, Andrzej T. Galecki, Jeffrey B. Halter, and Mark A. Supiano

VA Ann Arbor Healthcare System, Ann Arbor, MI, 48105; Department of Internal Medicine, University of Michigan, Ann Arbor, MI 49109; Geriatric Research, Education, and Clinical Center (GRECC), VA Ann Arbor Healthcare System, Ann Arbor, MI 48105

* To whom correspondence should be addressed. 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 {beta}-cell.

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

Design/Patients/Setting/Intervention: 214 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 (SI) and acute insulin response to glucose (AIRg) from FSIGT were compared with HOMA models.

Results: SI 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. both young NGT and old IGT for both SI and HOMA-IR). Agreement between HOMA-IR and SI 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 {beta}-cell was similar in the 3 groups. Agreement between HOMA {beta}-cell and AIRg was weak (weighted k=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.
Key words: Insulin resistance • insulin secretion • aged humans




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