Limited Value of the Homeostasis Model Assessment to Predict Insulin Resistance in Older Men With Impaired Glucose Tolerance

Abstract

OBJECTIVE— Insulin resistance (IR) in older individuals is associated with risk factors for coronary artery disease. The glucose clamp measures IR directly, but the homeostasis model assessment (HOMA) of IR,referred to here as HOMA-IR, is based on fasting glucose and insulin and is less invasive and labor intensive. This method requires validation in the elderly. RESEARCH DESIGN AND METHODS— We assessed the validity of HOMA-IR as an index of IR by comparing it to glucose infusion rates (GIRs)measured by a glucose clamp (600 pmol · m-2 ·min-1) in 45 obese men (61 ± 8 years of age, mean ±SD) with normal glucose tolerance (NGT) (n = 21) or impaired glucose tolerance (IGT) (n = 24). We also evaluated relationships between body composition, exercise capacity, and IR. RESULTS— Subjects with NGT had lower BMI (28 ± 3 vs. 31± 3 kg/m2), waist circumference (97 ± 9 vs. 105± 9 cm), waist-to-hip ratio (WHR) (0.93 ± 0.06 vs. 0.97 ±0.05), and percent body fat (25 ± 6 vs. 30 ± 6) than subjects with IGT. Subjects with NGT also had lower areas above basal during the 2-h oral glucose tolerance test for glucose (274 ± 95 vs. 419 ± 124 mmol · min/l) and insulin (38,142 ± 18,206 vs. 58,383 ±34,408 pmol · min/l) and lower HOMA-IR values (2.2 ± 0.8 vs. 4.2± 2.6) than subjects with IGT. GIR (μmol · kg-1FFM · min-1) was higher in subjects with NGT than in subjects with IGT (53 ± 11 vs. 43 ± 14). HOMA-IR correlated with GIR in subjects with NGT (r = -0.59), but not in subjects with IGT(r = -0.13). GIR correlated with Vo2max in subjects with NGT (r = 0.58) and IGT (r = 0.42), but with WHR only in subjects with NGT (r = -0.53). HOMA-IR correlated with Vo2max (r = -0.57) and waist circumference (r =0.54) in subjects with NGT, but with percent body fat in subjects with IGT(r = 0.54). CONCLUSIONS— These findings indicate that HOMA-IR should not be used as an index of IR in older individuals who may be at risk for IGT, and suggest that lifestyle changes that increase Vo2max and decrease body fat may reduce IR in older people.