✅ HOMA-IR Clinical uses and interpretation of HOMA-IR

HOMA-IR

Clinical uses and interpretation of HOMA-IR?

HOMA-IR is a simple surrogate marker used to estimate insulin resistance, calculated from fasting glucose and fasting insulin.

✅ Normal Values and Interpretation

There is no universal cut-off. Cutoffs vary by population, ethnicity, and assay used.

But clinical practice generally uses:

HOMA-IR Value Interpretation

< 1.0. Excellent insulin sensitivity

1.0 – 1.9. Normal insulin sensitivity

2.0 – 2.5 Early insulin resistance

2.5 – 3.9. Moderate insulin resistance

≥ 4.0 Severe insulin resistance / hyperinsulinemic state

For South Asian / Middle Eastern populations, even HOMA-IR > 2.0 already suggests significant insulin resistance.

Clinical Uses of HOMA-IR

HOMA-IR is most useful for:

1) Diagnosing insulin resistance

Especially in:

Obesity

Metabolic syndrome

Acanthosis nigricans

PCOS

Pre-diabetes

NAFLD / NASH

Because fasting glucose may be normal in these conditions, but fasting insulin is already high.

2) Risk Stratification

High HOMA-IR predicts:

Type 2 diabetes

Cardiovascular disease

Fatty liver disease progression

PCOS severity

Increased triglycerides

Higher uric acid

3) Monitoring response to therapy

HOMA-IR decreases with:

Weight loss

Exercise

Metformin

GLP-1 agonists (semaglutide, liraglutide)

SGLT-2 inhibitors

Low-carb / Mediterranean diets

Useful for follow-up every 3–6 months.

4) In PCOS

HOMA-IR is widely used to assess:

Severity of insulin resistance

Predict response to metformin

Reproductive outcomes

Cutoff: > 2.5 = IR in PCOS.

5) In Fatty Liver (NAFLD/NASH)

HOMA-IR strongly correlates with:

Fat deposition in the liver

Fibrosis progression

Cutoff often used: > 2.0

When NOT to use HOMA-IR

HOMA-IR is unreliable in:

Type 1 diabetes

Patients on insulin therapy

Elevated fasting glucose > 180 mg/dL

Acute illness

Pregnancy (use HOMA2 or clamps instead)

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