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Online Letters: Comments and Responses

Utility of Homeostasis Model Assessment of β-Cell Function in Predicting Diabetes in 12,924 Healthy Koreans

Response to Boyko

  1. Sun H. Kim, MD1,
  2. Ki-Chul Sung, MD, PHD2 and
  3. Gerald M. Reaven, MD1
  1. 1Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, California;
  2. 2Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Seoul, South Korea.
  1. Corresponding author: Sun H. Kim, sunhkim{at}stanford.edu.
Diabetes Care 2010 May; 33(5): e72-e72. https://doi.org/10.2337/dc10-0283
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We appreciate the thoughtful comments by Boyko (1). The premise of our study (2) was to understand whether homeostasis model assessment (HOMA) of β-cell function (HOMA-β) had utility in predicting diabetes development above and beyond glucose concentration in a large sample of individuals. We concluded that it did not. Even in narrowly defined glucose categories (normal fasting glucose [NFG], <5.6 mmol/l; impaired fasting glucose [IFG]-100, 5.6–6.0 mmol/l; and IFG-110, 6.1–6.9 mmol/l), baseline glucose concentrations were significantly higher in those who eventually developed diabetes; however, HOMA-β was either significantly higher or similar in those who developed diabetes. Although we adjusted our model for age, sex, and BMI, Boyko notes that we failed to adjust for “insulin resistance” (HOMA of insulin sensitivity [HOMA-S]) and our results are therefore biased. While we agree that there is a relationship between insulin resistance and secretion (3), what does it mean to adjust for HOMA-S using the HOMA calculation? Both HOMA-β and HOMA-S calculations involve inputting two variables—fasting glucose and insulin concentration. HOMA-S is nearly perfectly correlated with fasting insulin concentration; in our study, the r value was −0.99. Therefore, when one adjusts for HOMA-S or insulin concentration, glucose is the only value that varies in the HOMA-β calculation. When we adjusted HOMA-β for age, sex, BMI, and HOMA-S, indeed, HOMA-β was lower in individuals who developed diabetes: NFG group, 95 vs. 99 (P = 0.09); IFG-100, 75 vs. 80 (P< 0.001); and IFG-110, 67 vs. 69 (P < 0.001). However, this information merely reiterates the fact that fasting glucose was different in the population that developed diabetes. Other more “sophisticated” measures of insulin secretion have the same issue. For example, Boyko notes the decline in acute insulin response (AIR) with worsening glucose tolerance that is more pronounced after adjusting for insulin sensitivity using the minimal model. As with HOMA-β, AIR varies closely with fasting glucose concentration and is essentially abolished when fasting glucose concentration is <6.4 mmol/l (4). Because HOMA-β and AIR are in frequent use, it is important to recognize their limitations.

  • © 2010 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

References

  1. ↵
    1. Boyko EJ
    : Utility of homeostasis model assessment of β-cell function in predicting diabetes in 12,924 healthy Koreans: response to Sung, Reaven, and Kim (Letter). Diabetes Care 2010: 33: e71. DOI: 10.2337/dc10-0196
    OpenUrlFREE Full Text
  2. ↵
    1. Sung K-C,
    2. Reaven GM,
    3. Kim SH
    : Utility of homeostasis model assessment of beta-cell function in predicting diabetes in 12,924 healthy Koreans. Diabetes Care 2010; 33: 200– 202
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. Jones CN,
    2. Pei D,
    3. Staris P,
    4. Polonsky KS,
    5. Chen YD,
    6. Reaven GM
    : Alterations in the glucose-stimulated insulin secretory dose-response curve and in insulin clearance in nondiabetic insulin-resistant individuals. J Clin Endocrinol Metab 1997; 82: 1834– 1838
    OpenUrlCrossRefPubMedWeb of Science
  4. ↵
    1. Brunzell JD,
    2. Robertson RP,
    3. Lerner RL,
    4. Hazzard WR,
    5. Ensinck JW,
    6. Bierman EL,
    7. Porte D Jr
    : Relationships between fasting plasma glucose levels and insulin secretion during intravenous glucose tolerance tests. J Clin Endocrinol Metab 1976; 42: 222– 229
    OpenUrlCrossRefPubMedWeb of Science
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Utility of Homeostasis Model Assessment of β-Cell Function in Predicting Diabetes in 12,924 Healthy Koreans
Sun H. Kim, Ki-Chul Sung, Gerald M. Reaven
Diabetes Care May 2010, 33 (5) e72; DOI: 10.2337/dc10-0283

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Utility of Homeostasis Model Assessment of β-Cell Function in Predicting Diabetes in 12,924 Healthy Koreans
Sun H. Kim, Ki-Chul Sung, Gerald M. Reaven
Diabetes Care May 2010, 33 (5) e72; DOI: 10.2337/dc10-0283
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