HOMA-IR and QUICKI: Decide on a general standard instead of making further comparisons

Department of Woman and Child Health, Division of Pediatrics, Karolinska Institute, Stockholm, Sweden.
Acta Paediatrica (Impact Factor: 1.67). 11/2010; 99(11):1735-40. DOI: 10.1111/j.1651-2227.2010.01911.x
Source: PubMed


To limit further comparisons between the two fasting indices Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI), and to examine their robustness in assessing insulin sensitivity.
A total of 191 obese children and adolescents (age 13.9 ± 2.9 years, BMI SDS 6.1 ± 1.6), who had undergone a Frequently Sampled Intravenous Glucose Tolerance Test (FSIVGTT), were included. Receiver operating characteristic curve (ROC) analysis was used to compare indices in detecting insulin resistance and Bland-Altman plots to investigate agreement between three consecutive fasting samples when compared to using single samples.
ROC analysis showed that the diagnostic accuracy was identical for QUICKI and HOMA-IR [area under the curve (AUC) boys 0.80, 95%CI 0.70-0.89; girls 0.80, 0.71-0.88], while insulin had a nonsignificantly lower AUC (boys 0.76, 0.66-0.87; girls 0.75, 0.66-0.84). Glucose did not perform better than chance as a diagnostic test (boys 0.47, 0.34-0.60; girls 0.57, 0.46-0.68). Indices varied with consecutive sampling, mainly attributable to fasting insulin variations (mean maximum difference in HOMA-IR -0.8; -0.9 to -0.7).
Using both HOMA-IR and QUICKI in further studies is superfluous as these indices function equally well as predictors of the FSIVGTT sensitivity index. Focus should be on establishing a general standard for research and clinical purposes.

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    • "Third, our subject population was largely exposed to AAPs with known metabolic side effects which makes translation of our results to other disease populations or populations exposed to other medications challenging. Fourth, we used a surrogate measure of insulin resistance, which, although not a direct measure of insulin resistance, has been highly correlated to more invasive measures such as the glucose clamps and the oral glucose tolerance test [25, 26]. HOMA-IR was used to make our findings more translatable to the clinic setting but more direct measures of insulin resistance would be useful in supporting our study's results. "
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