The relation between parameters from homeostasis model assessment and glycemic control in type 2 diabetes.
OBJECTIVE
To determine the association of insulin sensitivity and pancreatic beta-cell function parameters assessed by the homeostasis model assessment (HOMA) and glycemic control, and their potential utilization in the clinical care of patients with type 2 diabetes mellitus.


METHODS
The HOMA indices were assessed in 204 (62 males, 142 females) type 2 diabetic outpatients aged 60.7 +/- 10.9 years. All patients were non-insulin treated for their diabetes. The correlation between variables including logarithmically transformed HOMA-%S and HOMA-%B, body mass index (BMI) and duration of diabetes to glycemic control were assessed The value of the disposition index (HOMA-%SxHOMA-%B) that best discriminated patients with good glycemic control (HbA1C < 7%) from those without (HbA1C > or = 7%) was determined.


RESULTS
Both log (HOMA-%S) and log (HOMA-%B) were inversely related to HbA1C with comparable degrees of association (beta = -0.62, p < 0.001 and beta = -0.61, p < 0.001, respectively). The log-transformed disposition index of at least 3.57 had a sensitivity of 74.2% and a specificity of 67.6% in classifying patients as having HbA1C < 7%. The result suggested that in order to achieve acceptable glycemic control, oral hypoglycemic agents should be adjusted to maximize the likelihood of the log-transformed disposition index reaching 3.57.


CONCLUSIONS
Glycemic control in diabetic patients partially depends on both insulin sensitivity and pancreatic beta-cell function. Assessing both parameters with the HOMA model is likely to result in a more rational approach for achieving better glycemic control in type 2 diabetic patients.
Dansuntornwong
Bantita
B
Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Chanprasertyothin
Suwannee
S
Jongjaroenprasert
Wallaya
W
Ngarmukos
Chardpraon
C
Bunnag
Pongamorn
P
Puavilai
Gobchai
G
Ongphiphadhanakul
Boonsong
B
D001786:Blood Glucose; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin; D006305:Health Status Indicators; D006487:Hemostasis; D006801:Humans; D007004:Hypoglycemic Agents; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D008962:Models, Theoretical; D010865:Pilot Projects; D018434:Sickness Impact Profile
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents