Published online August 1, 2005
PEDIATRICS
Vol. 116
No. 2
August 2005, pp.
515
(doi:10.1542/peds.2005-1051)
Is Homeostasis Model Assessment Better Than the Quantitative Insulin-Sensitivity Check Index and Fasting Glucose/Insulin Ratio?
Angelika Mohn, MD
Maria Marcovecchio, MD
Francesco Chiarelli, MD
Department of Pediatrics
University of Chieti
Chieti 66100, Italy
To the Editor.—
We read with great
interest the article of Keskin and
colleagues,1
who tried to establish whether fasting methods to measure insulin
resistance (homeostasis model assessment [HOMA], fasting
glucose/insulin ratio, quantitative insulin-sensitivity check index)
are reliable and which index could be used more easily in a clinical
setting. Insulin resistance is an emerging topic, because it plays a
central role in developing type 2 diabetes and the metabolic syndrome,
particularly in an overweight adolescent population such as the one
studied by the
authors.2
The markers proposed by the authors were validated recently with the
euglycemic clamp technique, which represents the gold standard for the
determination of insulin resistance, and a good correlation between
them has been
found.3
Moreover, the reliability of the composite whole-body
insulin-sensitivity index and the insulin-sensitivity index, both
deriving from the oral glucose-tolerance test, has also been validated
in children and adolescents, and a strong correlation between these 2
indices and the euglycemic clamp has been
found.4
On the contrary, no data on the accuracy of the sum of insulin levels
during the oral glucose-tolerance test as an index of insulin
resistance are available. In previous studies this index has only been
used to subdivide obese patients as normoinsulinemic or
hyperinsulinemic.5,6
In the study by Keskin et al, obese adolescents are classified as
insulin resistant versus non–insulin resistant on the basis of
a cutoff of this index of 300 µU/L. This is more than
questionable and might have influenced the main results of the study.
In fact, given the nonvalidation of this index, it is difficult to
conclude that HOMA is more reliable than the fasting glucose/insulin
ratio and quantitative insulin-sensitivity check index in diagnosing
insulin resistance, and it is more than surprising to determine an
appropriate cutoff point for HOMA for the diagnosis of insulin
resistance in
adolescents.
REFERENCES
- Keskin M, Kurtoglu S, Kendirci M, Atabek M, Yazici C. Homeostasis model assessment is more reliable than fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents.
Pediatrics. 2005;115(4)
Available at: www.pediatrics.org/cgi/content/full/115/4/e500
- American Diabetes Association. Type 2 diabetes in children and adolescents.
Pediatrics. 2000;105
:671
–680[Free Full Text]
- Gungor N, Saad R, Janosky J, Arslanian S. Validation of surrogate estimates of insulin sensitivity and insulin secretion in children and adolescents.
J Pediatr. 2004;144
:47
–55[CrossRef][ISI][Medline]
- Yeckel C, Weiss R, Dziura J, et al. Validation of insulin sensitivity indices from oral glucose tolerance test parameters in obese children and adolescents.
J Clin Endocrinol Metab. 2004;89
:1096
–1101[Abstract/Free Full Text]
- Zannolli R, Rebeggiani A, Chiarelli F, Morgese G. Hyperinsulinism as a marker in obese children.
Am J Dis Child. 1993;147
:837
–841[Abstract]
- Maruhama Y, Abe R. A familial form of obesity without hyperinsulinemia at the outset.
Diabetes. 1981;30(1)
:14
–18
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
