Background and Objectives: The key pathogenetic mechanism of glucose metabolism disorders, insulin resistance (IR), can be assessed using the Homeostasis Model Assessment of IR (HOMA-IR). However, its application in clinical practice is limited due to the absence of cut-offs. In this study, we aimed to define the cut-offs for the Czech population. Methods: After undergoing anthropometric and biochemical studies, the sample of 3539 individuals was divided into either nondiabetics, including both subjects with normal glucose tolerance (NGT, n = 1947) and prediabetics (n = 1459), or diabetics (n = 133). The optimal HOMA-IR cut-offs between subgroups were determined to maximize the sum of the sensitivity and specificity for diagnosing type 2 diabetes mellitus (T2DM) or prediabetes. The predictive accuracy was illustrated using receiver operating characteristic (ROC) curves. Logistic regression was performed to assess the association between a target variable (presence/absence of T2DM) depending on the HOMA-IR score as well as on the age and sex. Results: The HOMA-IR cut-off between nondiabetics and diabetics for both sexes together was 3.63, with a sensitivity of 0.56 and a specificity of 0.86. The area under the ROC curve was 0.73 for T2DM diagnosing in both sexes. The HOMA-IR cut-off between the NGT subjects and prediabetics was 1.82, with a sensitivity of 0.60 and a specificity of 0.66. Logistic regression showed that increased HOMA-IR is a risk factor for the presence of T2DM (odds ratio (OR) 1.2, 95% confidence interval (CI) 1.14-1.28, p < 0.0001). The predictive ability of HOMA-IR in diagnosing T2DM is statistically significantly lower in females (OR 0.66, 95% CI 0.44-0.98). The results are valid for middle-aged European adults. Conclusions: The results suggest the existence of HOMA-IR cut-offs signaling established IR. Introduction of the instrument into common clinical practice, together with the known cut-offs, may contribute to preventing T2DM.

Ambulance Prof MUDr Karla Martiníka DrSc s r o Bratří Štefanů 895 50003 Hradec Králové Czech Republic

Department of Healthcare Management Faculty of Health Sciences Palacký University Olomouc Hněvotínská 3 77515 Olomouc Czech Republic

Department of Public Health Faculty of Medicine and Dentistry Palacký University Olomouc Hněvotínská 3 77515 Olomouc Czech Republic

Institute of Biophysics and Informatics 1st Faculty of Medicine Charles University Salmovská 1 12000 Prague Czech Republic

ReFit Clinic s r o U Reálky 4 77900 Olomouc Czech Republic

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Oni T., Unwin N. Why the communicable/non-communicable disease dichotomy is problematic for public health control strategies: Implications of multimorbidity for health systems in an era of health transition. Int. Health. 2015;7:390–399. doi: 10.1093/inthealth/ihv040. PubMed DOI PMC

Casagrande S.S., Menke A., Linder B., Osganian S.K., Cowie C.C. Cardiovascular risk factors in adolescents with prediabetes. Diabet. Med. 2018;35:1202–1209. doi: 10.1111/dme.13661. PubMed DOI PMC

Yamada C., Mitsuhashi T., Hiratsuka N., Inabe F., Araida N., Takahashi E. Optimal reference interval for homeostasis model assessment of insulin resistance in a Japanese population. J. Diabetes Investig. 2011;2:373–376. doi: 10.1111/j.2040-1124.2011.00113.x. PubMed DOI PMC

Tang Q., Li X., Song P., Xu L. Optimal cut-off values for the homeostasis model assessment of insulin resistance (HOMA-IR) and pre-diabetes screening: Developments in research and prospects for the future. Drug Discov. Ther. 2015;9:380–385. doi: 10.5582/ddt.2015.01207. PubMed DOI

Lee C.H., Shih A.Z., Woo Y.C., Fong C.H., Leung O.Y., Janus E., Cheung B.M., Lam K.S. Optimal cut-offs of homeostasis model assessment of insulin resistance (HOMA-IR) to identify dysglycemia and type 2 diabetes mellitus: A 15-year prospective study in Chinese. PLoS ONE. 2016;11:e0163424. doi: 10.1371/journal.pone.0163424. PubMed DOI PMC

Pisprasert V., Ingram K.H., Lopez-Davila M.F., Munoz A.J., Garvey W.T. Limitations in the use of indices using glucose and insulin levels to predict insulin sensitivity: Impact of race and gender and superiority of the indices derived from oral glucose tolerance test in African Americans. Diabetes Care. 2013;36:845–853. doi: 10.2337/dc12-0840. PubMed DOI PMC

Matthews D.R., Hosker J.P., Rudenski A.S., Naylor B.A., Treacher D.F., Turner R.C. Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–419. doi: 10.1007/BF00280883. PubMed DOI

Ruopp M.D., Perkins N.J., Whitcomb B.W., Schisterman E.F. Youden index and optimal cut-point estimated from observations affected by a lower limit of detection. Biom. J. 2008;50:419–430. doi: 10.1002/bimj.200710415. PubMed DOI PMC

Alberti K.G.M.M., Eckel R.H., Grundy S.M., Zimmet P.Z., Cleeman J.I., Donato K.A., Fruchart J.C., James W.P.T., Loria C.M., Smith S.C., Jr. Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–1645. doi: 10.1161/CIRCULATIONAHA.109.192644. PubMed DOI

Bonora E., Targher G., Alberiche M., Bonadonna R.C., Saggiani F., Zenere M.B., Monauni T., Muggeo M. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: Studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care. 2000;23:57–63. doi: 10.2337/diacare.23.1.57. PubMed DOI

Wallace T.M., Levy J.C., Matthews D.R. Use and abuse of HOMA modeling. Diabetes Care. 2004;27:1487–1495. doi: 10.2337/diacare.27.6.1487. PubMed DOI

Diabetes Prevention Program Research Group. Knowler W.C., Fowler S.E., Hamman R.F., Christophi C.A., Hoffman H.J., Brenneman A.T., Brown-Friday J.O., Goldberg R., Venditti E., et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374:1677–1686. doi: 10.1016/S0140-6736(09)61457-4. PubMed DOI PMC

Sumner A.E., Cowie C.C. Ethnic differences in the ability of triglyceride levels to identify insulin resistance. Atherosclerosis. 2008;196:696–703. doi: 10.1016/j.atherosclerosis.2006.12.018. PubMed DOI

Drabsch T., Holzapfel C., Stecher L., Petzold J., Skurk T., Hauner H. Associations between C-reactive protein, insulin sensitivity, and resting metabolic rate in adults: A mediator analysis. Front. Endocrinol. (Lausanne) 2018;9:556. doi: 10.3389/fendo.2018.00556. PubMed DOI PMC

Zhong V.W., Bancks M.P., Schreiner P.J., Lewis C.E., Steffen L.M., Meigs J.B., Schrader L.A., Schorr M., Miller K.K., Sidney S., et al. Insulin resistance since early adulthood and appendicular lean mass in middle-aged adults without diabetes: 20 years of the CARDIA study. J. Diabetes Complications. 2019;33:84–90. doi: 10.1016/j.jdiacomp.2018.09.011. PubMed DOI PMC

Cӑtoi A.F., Pârvu A.E., Andreicuț A.D., Mironiuc A., Crӑciun A., Cӑtoi C., Pop I.D. Metabolically healthy versus unhealthy morbidly obese: Chronic inflammation, nitro-oxidative stress, and insulin resistance. Nutrients. 2018;10:1199. doi: 10.3390/nu10091199. PubMed DOI PMC

Freeman A.M., Pennings N. Insulin Resistance. [(accessed on 15 December 2018)]; Available online: https://www.ncbi.nlm.nih.gov/books/NBK507839/

Singh Y., Garg M.K., Tandon N., Marwaha R.K. A study of insulin resistance by HOMA-IR and its cut-off value to identify metabolic syndrome in urban Indian adolescents. J. Clin. Res. Pediatr. Endocrinol. 2013;5:245–251. doi: 10.4274/Jcrpe.1127. PubMed DOI PMC

Cardenas-Vargas E., Nava J.A., Garza-Veloz I., Torres-Castañeda M.C., Galván-Tejada C.E., Cid-Baez M.A., Castañeda-Arteaga R.E., Ortiz-Castro Y., Trejo-Ortiz P.M., Araujo-Espino R., et al. The influence of obesity on puberty and insulin resistance in Mexican children. Int. J. Endocrinol. 2018;2018:7067292. doi: 10.1155/2018/7067292. PubMed DOI PMC

Diabetes Prevention Program Research Group. Perreault L., Pan Q., Mather K.J., Watson K.E., Hamman R.F., Kahn S.E. Effect of regression from prediabetes to normal glucose regulation on long-term reduction in diabetes risk: Results from the Diabetes Prevention Program Outcomes Study. Lancet. 2012;379:2243–2251. doi: 10.1016/S0140-6736(12)60525-X. PubMed DOI PMC

Kang E.S., Yun Y.S., Park S.W., Kim H.J., Ahn C.W., Song Y.D., Cha B.S., Lim S.K., Kim K.R., Lee H.C. Limitation of the validity of the homeostasis model assessment as an index of insulin resistance in Korea. Metabolism. 2005;54:206–211. doi: 10.1016/j.metabol.2004.08.014. PubMed DOI

Cholesterol and glucose profiles according to different fasting C-peptide levels: a cross-sectional analysis in a healthy cohort from the Czech Republic

The Changes of Cholesterol Profile at the Different Insulin Resistance Range in the Czech Republic

Alterations of glycaemia, insulin resistance and body mass index within the C-peptide optimal range in non-diabetic patients