Homeostatic model assessment

Derivation

The HOMA authors used data from physiological studies to develop mathematical equations describing glucose regulation as a feedback loop. They published computer software that solves the equations, so that insulin resistance and β-cell function can be estimated from fasting glucose and insulin levels. They also published an equation (see below) that gave approximately the same answers as an early version of the computer software.

The computer model has since been improved to a HOMA2 model

Notes

The HOMA model was originally designed as a special case of a more general structural (HOMA-CIGMA) model that includes the continuous infusion of glucose with model assessment (CIGMA) approach; both techniques use mathematical equations to describe the functioning of the major effector organs influencing glucose/insulin interactions.

The approximating equation for insulin resistance, in the early model, used a fasting plasma sample, and was derived by use of the insulin-glucose product, divided by a constant: (assuming normal-weight, normal subjects

IR is insulin resistance and ** %β ** is the β-cell function (more precisely, an index for glucose tolerance, i.e. a measure for the ability to counteract the glucose load). Insulin is given in μU/mL. Glucose and insulin are both during fasting.

This model correlated well with estimates using the euglycemic clamp method (r = 0.88).

The authors have tested HOMA and HOMA2 extensively against other measures of insulin resistance (or its reciprocal, insulin sensitivity) and β-cell function.

The approximation formulae above relate to HOMA and are crude estimates of the model near normal levels of glucose and insulin in man. The actual calculated HOMA2 compartmental model is published and is available online.

References

References

1. (1979). "Insulin deficiency and insulin resistance interaction in diabetes: estimation of their relative contribution by feedback analysis from basal plasma insulin and glucose concentrations.". Metabolism.
2. (1985). "Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.". Diabetologia.
3. (2004). "Use and abuse of HOMA modeling.". Diabetes Care.
4. (1998). "Correct homeostasis model assessment (HOMA) evaluation uses the computer program.". Diabetes Care.
5. Turner et al. (1993) ''Measurement of insulin resistance and β-cell function: the HOMA and CIGMA approach.'' Current topics in diabetes research (eds) F. Belfiore, R. Bergman and G. Molinatti Front Diabetes. Basel, Karger 12: 66-75
6. (May 2010). "Surrogate markers of insulin resistance: A review". World J Diabetes.
7. (1999). "Comparison of tests of beta-cell function across a range of glucose tolerance from normal to diabetes.". Diabetes.
8. (1999). "Comparison of insulin sensitivity tests across a range of glucose tolerance from normal to diabetes.". Diabetologia.
9. (2013). "Expansion of the homeostasis model assessment of β-cell function and insulin resistance to enable clinical trial outcome modeling through the interactive adjustment of physiology and treatment effects: iHOMA2.". Diabetes Care.