Abstract
AimWe have recently determined the optimal cut-off of the homeostatic model assessment of insulin resistance for the diagnosis of insulin resistance (IR) and metabolic syndrome (MetS) in non-diabetic residents of Tehran, the capital of Iran. The aim of the present study is to establish the optimal cut-off at the national level in the Iranian population with and without diabetes.MethodsData of the third National Surveillance of Risk Factors of Non-Communicable Diseases, available for 3,071 adult Iranian individuals aging 25-64 years were analyzed. MetS was defined according to the Adult Treatment Panel III (ATPIII) and International Diabetes Federation (IDF) criteria. HOMA-IR cut-offs from the 50th to the 95th percentile were calculated and sensitivity, specificity, and positive likelihood ratio for MetS diagnosis were determined. The receiver operating characteristic (ROC) curves of HOMA-IR for MetS diagnosis were depicted, and the optimal cut-offs were determined by two different methods: Youden index, and the shortest distance from the top left corner of the curve.ResultsThe area under the curve (AUC) (95%CI) was 0.650 (0.631-0.670) for IDF-defined MetS and 0.683 (0.664-0.703) with the ATPIII definition. The optimal HOMA-IR cut-off for the diagnosis of IDF- and ATPIII-defined MetS in non-diabetic individuals was 1.775 (sensitivity: 57.3%, specificity: 65.3%, with ATPIII; sensitivity: 55.9%, specificity: 64.7%, with IDF). The optimal cut-offs in diabetic individuals were 3.875 (sensitivity: 49.7%, specificity: 69.6%) and 4.325 (sensitivity: 45.4%, specificity: 69.0%) for ATPIII- and IDF-defined MetS, respectively.ConclusionWe determined the optimal HOMA-IR cut-off points for the diagnosis of MetS in the Iranian population with and without diabetes.
Highlights
Insulin resistance, which represents a reduced physiological response of the peripheral tissues to the action of the normal levels of insulin, is amajor finding in several metabolic disorders, including type 2 diabetes and metabolic syndrome (MetS) [1]
A higher proportion of women had Adult Treatment Panel III (ATPIII)-defined MetS (39.0% vs. 28.3% in men, P < 0.001), International Diabetes Federation (IDF)-defined MetS prevalence was similar in both genders (34.0% in men and 35.5% in women)
Regardless of the diabetes status, the prevalence of MetS was substantially higher in older ages for any given HOMA-insulin resistance (IR) threshold
Summary
Insulin resistance, which represents a reduced physiological response of the peripheral tissues to the action of the normal levels of insulin, is amajor finding in several metabolic disorders, including type 2 diabetes and metabolic syndrome (MetS) [1]. The homeostasis model assessment of insulin resistance (HOMA-IR), which is developed for application in large epidemiologic investigations [4], is an alternative to the glucose clamp and the most commonly used surrogate measure of insulin resistance in vivo. In terms of precision (reproducibility of measure), HOMA-IR is comparable to the glucose clamp technique. HOMA-IR is inferior to the clamp technique in terms of accuracy, but using HOMA-IR makes it possible to study a large number of subjects and with a single glucose and insulin measurement in the fasting state [5]. HOMA-IR may serve as a surrogate measure of the insulin resistance phenotype, as it identifies a proportion of subjects with insulin resistance without directly measuring insulin action [19,20]
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