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Insulin Sensitivity and Insulin Secretion Determined by the Homeostasis Model Assessment (HOMA) and Risk of Diabetes Mellitus in a Multi-Ethnic Cohort of Women: The Women's Health Initiative Observational Study

¹Division of Preventive Medicine, Medicine, Brigham and Women's Hospital, Boston, Massachusetts
²Epidemiology, Harvard School of Public Health, Boston, Massachusetts
³Public Health Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
⁴MedStar Research Institute, Washington, D.C
⁵Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
⁶Obstetrics and Gynecology, University of California, Los Angeles, California
⁷Children's Hospital, Boston, Massachusetts
⁸Epidemiology, and
⁹David Geffen School of Medicine, University of California, Los Angeles, California

siminliu{at}ucla.edu

ABSTRACT

OBJECTIVE: The homeostasis model assessment (HOMA) based on plasma levels of fasting glucose and insulin has been widely validated and applied for quantifying insulin resistance and ß-cell function. However, prospective data regarding its relation to diabetes risk in ethnically diverse populations are limited.

RESEARCH DESIGN AND METHODS: Among 82,069 women aged 50 to 79 years free of cardiovascular disease or diabetes participating in the Women's Health Initiative Observational Study (WHI-OS), we conducted a nested case-control study to prospectively examine the relations of HOMA-insulin resistance (HOMA-IR) and ß-cell function (HOMA-%B) with diabetes risk. During a median follow-up period of 5.9 years, 1,584 diabetes patients were matched with 2,198 controls by age, ethnicity, clinical center, time of blood draw, and follow-up time.

RESULTS: Baseline levels of fasting glucose, insulin, and HOMA-IR were each significantly higher among cases than controls while HOMA-%B was lower (all P values<0.0001). After adjustment for matching factors and diabetes risk factors, all four markers were significantly associated with diabetes risk; the estimated relative risks (RRs) per standard deviation increment were 3.54 (95% CI, 3.02-4.13) for fasting glucose, 2.25 (1.99-2.54) for fasting insulin, 3.40 (2.95-3.92) for HOMA-IR, and 0.57(0.51-0.63) for HOMA-%B. While no statistically significant multiplicative interactions were observed between these markers and ethnicity, the associations of both HOMA-IR and HOMA-%B with diabetes risk remained significant and robust in each ethnic group including Whites, Blacks, Hispanics, and Asians/Pacific Islanders. When evaluated jointly, the relations of HOMA-IR and HOMA-%B with diabetes risk appeared to be independent and additive. HOMA-IR was more strongly associated with an increased risk than were other markers after we excluded those with a fasting glucose 126 mg/dl at baseline.

CONCLUSIONS: High HOMA-IR and low HOMA%B were independently and consistently associated with an increased diabetes risk in a multi-ethnic cohort of US postmenopausal women. These data suggest the values of HOMA indices for diabetes risk in epidemiologic studies.

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This article has been cited by other articles:

				E. J. Boyko, D. Magliano, and J. E. Shaw Insulin Sensitivity and Insulin Secretion Determined by Homeostasis Model Assessment and Risk of Diabetes in a Multiethnic Cohort of Women: the Women's Health Initiative Observational Study: Response to Song et al. Diabetes Care, November 1, 2007; 30(11): e110 - e110. [Full Text] [PDF]

				Y. Song and S. Liu Insulin Sensitivity and Insulin Secretion Determined by Homeostasis Model Assessment and Risk of Diabetes in a Multiethnic Cohort of Women: the Women's Health Initiative Observational Study: Response to Boyko et al. Diabetes Care, November 1, 2007; 30(11): e111 - e111. [Full Text] [PDF]

				E. J. Boyko and C. C. Jensen Do We Know What Homeostasis Model Assessment Measures?: If not, does it matter? Diabetes Care, October 1, 2007; 30(10): 2725 - 2728. [Full Text] [PDF]