Biological variation of homeostasis model assessment-derived insulin resistance in type 2 diabetes.
OBJECTIVE
Individuals with type 2 diabetes are particularly vulnerable to cardiovascular disease. Insulin resistance is a major determinant of this increased risk and is a potential therapeutic target. This study was undertaken to establish the natural biological variation of insulin resistance in individuals with type 2 diabetes.


METHODS
The biological variation of insulin resistance was assessed by measuring insulin resistance at 4-day intervals on 10 consecutive occasions in 12 postmenopausal women with diet-controlled type 2 diabetes and in 11 weight- and age-matched postmenopausal women without type 2 diabetes. Insulin resistance was derived using the homeostasis model assessment for insulin resistance (HOMA-IR) method.


RESULTS
The distribution of HOMA-IR was log Gaussian in the type 2 diabetic study group and Gaussian in the control group. The HOMA-IR in the type 2 diabetic group was significantly greater than that of the control group (mean +/- SD: 4.33 +/- 2.3 vs. 2.11 +/- 0.79 units, P = 0.001). After accounting for analytical variation, the mean intraindividual variation was also substantially greater in the type 2 diabetic group than in the control group (mean 1.05 vs. 0.15, P = 0.001). Consequently, at any level of HOMA-IR, a subsequent sample must increase by >90% or decrease by >47% to be considered significantly different from the first.


CONCLUSIONS
HOMA-IR is significantly greater and more variable for individuals with type 2 diabetes. Therefore, this inherent variability needs to be accounted for in studies evaluating therapeutic reduction of HOMA-IR in this group.
Jayagopal
Vijay
V
Department of Medicine, University of Hull, Hull, U.K. v.jaygopal@hull.ac.uk
Kilpatrick
Eric S
ES
Jennings
Paul E
PE
Hepburn
David A
DA
Atkin
Stephen L
SL
D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003927:Diet, Diabetic; D004739:England; D005260:Female; D006706:Homeostasis; D006801:Humans; D007333:Insulin Resistance; D008875:Middle Aged; D008954:Models, Biological; D017698:Postmenopause; D012016:Reference Values; D015203:Reproducibility of Results; D044465:White People