Published online August 1, 2005
PEDIATRICS Vol. 116 No. 2 August 2005, pp. 515 (doi:10.1542/10.1542/peds.2005-1051)

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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

1. 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
2. American Diabetes Association. Type 2 diabetes in children and adolescents. Pediatrics. 2000;105 :671 –680[Free Full Text]
3. 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][Web of Science][Medline]
4. 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]
5. Zannolli R, Rebeggiani A, Chiarelli F, Morgese G. Hyperinsulinism as a marker in obese children. Am J Dis Child. 1993;147 :837 –841[Abstract/Free Full Text]
6. Maruhama Y, Abe R. A familial form of obesity without hyperinsulinemia at the outset. Diabetes. 1981;30(1) :14 –18

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PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Mohn, A. Articles by Chiarelli, F. Search for Related Content PubMed PubMed Citation Articles by Mohn, A. Articles by Chiarelli, F. Related Collections Endocrinology Social Bookmarking                         What's this?