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Sugar and metabolism · Blood
HOMA-IR
A calculation from fasting glucose and insulin as an estimate of insulin resistance; mainly a research measure, without a fixed cutoff value.
At a glance
- Measured in blood
- In 4 test panels
- Check the preparation
Explanation
HOMA-IR: what is measured?
HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) is not a measurement but a formula: fasting glucose (mmol/l) times fasting insulin (mU/l), divided by 22.5. The more insulin is needed to reach a certain blood sugar level, the higher the outcome. The measure was developed in 1985 to estimate insulin resistance in population studies without a complicated clamp test. Because the formula relies on a single fasting insulin value, it takes on all the uncertainties of that measurement.
What can it detect?
- Reduced sensitivity of muscles, liver and fat to insulin (insulin resistance), especially with overweight and metabolic syndrome
- An early stage of disturbed sugar metabolism while the glucose itself is still normal
Result
What does the result mean?
HOMA-IR too high
A high HOMA-IR means that relatively much insulin is needed to keep the fasting blood sugar normal, and it fits insulin resistance. This mainly occurs with overweight around the belly, little exercise, PCOS, disturbed fat metabolism and in the run-up to type 2 diabetes. It does not cause symptoms. Which value counts as 'high' differs by study and by laboratory (about 2 to 2.5 is often used as the cutoff), and a slightly raised outcome occurs in many healthy people with a normal weight. Not being fasting, stress, illness, lack of sleep and medicines such as corticosteroids falsely raise the outcome.
HOMA-IR too low
A low HOMA-IR fits good insulin sensitivity and is normal in healthy people; it is not a reason for further tests. A low outcome can also be misleading: in type 1 diabetes or in longer-standing type 2 diabetes, the pancreas makes little insulin, so the formula comes out low while the blood sugar is high. The outcome must therefore always be read alongside the separate glucose and insulin values.
After an abnormal result
The GP assesses a high HOMA-IR based on the underlying glucose and insulin values, weight, blood pressure and lipid values; the next step is lifestyle advice and, with a raised risk, periodic checks of fasting glucose. An isolated high HOMA-IR does not lead to medicines or a referral.
Reliability
How reliable is the test?
HOMA-IR is a single, derived value with limited predictive value for the individual. Diabetes is diagnosed with fasting glucose and HbA1c, which have fixed cutoff values (the Dutch GP guideline (NHG) on type 2 diabetes mellitus). In practice, insulin resistance is estimated using weight, waist circumference, blood pressure, triglycerides and HDL. HOMA-IR is useful for comparing groups in research, but there is no agreed cutoff value, no evidence that measuring it improves the outcome for the person, and no treatment that is guided by the value. An abnormal outcome is an indication, not a diagnosis.
What can affect the result?
- All limitations of the insulin measurement also apply here: being strictly fasting, quick processing of the tube, and measuring methods that differ by tens of percent between laboratories, so the same person can get a different outcome at another laboratory.
- The formula does not give a usable outcome if the pancreas makes too little insulin (type 1 diabetes, advanced type 2 diabetes) or in people who inject insulin.
- The cutoff value for 'insulin resistant' has not been established and differs by population group and study; laboratory reference ranges are conventions.
- Stress, illness, lack of sleep, heavy exercise the day before, pregnancy and medicines such as corticosteroids, antipsychotics and oral contraceptives affect the outcome.
Preparation
- HOMA-IR is calculated from your fasting glucose and insulin. So do not eat anything for 12 hours before the sample is taken and drink only water.
- Do you take biotin (vitamin B8, often in hair and nail supplements)? Stop at least 2 days before the sample is taken, or 4 days for a high dose.
Who it is for
Who is the test useful for?
Useful for
If you want to know whether your blood sugar is disturbed, fasting glucose (and HbA1c if you have a raised risk) is more useful, because these have fixed cutoff values. The measure is mainly used in research and sometimes by specialists with PCOS or fatty liver. If you have the value calculated out of interest, for example with overweight or diabetes in the family, you should know that a high outcome is not a diagnosis and that the advice (exercise more, eat more healthily, lose weight) does not depend on the outcome.
How common is it?
Insulin resistance is not a registered diagnosis; there are no figures for the Netherlands on how often a raised HOMA-IR occurs. However, in 2024 more than 1.1 million people with type 2 diabetes were known to their GP (61 per 1000 inhabitants), and according to the Dutch GP guideline (NHG), about 30 percent of people over 60 have impaired fasting glucose or impaired glucose tolerance, in which insulin resistance almost always plays a role.
VZinfo (RIVM) based on Nivel Primary Care Database, 2024; NHG guideline on type 2 diabetes mellitus
Drawbacks and risks
- Online, a high HOMA-IR is often presented as 'insulin resistance' or 'prediabetes'; without an agreed cutoff value and with a variable insulin measurement, this can cause unnecessary worry or lead to unproven treatments.
- A low or normal outcome can give false reassurance, especially if the pancreas is already making less insulin.
Get tested
HOMA-IR: test panels
HOMA-IR is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.
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€ 44,00
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Evidence
Sources
This explanation is based on Dutch guidelines and independent information. It is general information, not a diagnosis. Discuss an abnormal result with your GP.
More about risks and results