Insulin sensitivity and insulin secretion determined by homeostasis model assessment and risk of diabetes in a multiethnic cohort of women

The women's health initiative observational study

Yiqing Song, Joann E. Manson, Lesley Tinker, Barbara V. Howard, Lewis H. Kuller, Lauren Nathan, Nader Rifai, Simin Liu

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE - The homeostasis model assessment (HOMA), based on plasma levels of fasting glucose and insulin, has been widely validated and applied for quantifying insulin resistance and β-cell function. However, prospective data regarding its relation to diabetes risk in ethnically diverse populations are limited. RESEARCH DESIGN AND METHODS - Among 82,069 women who were aged 50-79 years, free of cardiovascular disease or diabetes, and participating in the Women's Health Initiative Observational Study, we conducted a nested case-control study to prospectively examine the relations of HOMA of insulin resistance (HOMA-IR) and β-cell function (HOMA-B) with diabetes risk. During a median follow-up period of 5.9 years, 1,584 diabetic patients were matched with 2,198 control subjects by age, ethnicity, clinical center, time of blood draw, and follow-up time. RESULTS - Baseline levels of fasting glucose, insulin, and HOMA-IR were each significantly higher among case compared with control subjects, while HOMA-B was lower (all P values <0.0001). After adjustment for matching factors and diabetes risk factors, all four markers were significantly associated with diabetes risk; the estimated relative risks per SD increment were 3.54 (95% CI 3.02-4.13) for fasting glucose, 2.25 (1.99-2.54) for fasting insulin, 3.40 (2.95-3.92) for HOMA-IR, and 0.57(0.51-0.63) for HOMA-B. While no statistically significant multiplicative interactions were observed between these markers and ethnicity, the associations of both HOMA-IR and HOMA-B with diabetes risk remained significant and robust in each ethnic group, including whites, blacks, Hispanics, and Asians/Pacific Islanders. When evaluated jointly, the relations of HOMA-IR and HOMA-B with diabetes risk appeared to be independent and additive. HOMA-IR was more strongly associated with an increased risk than were other markers after we excluded those with fasting glucose ≥126 mg/dl at baseline. CONCLUSIONS - High HOMA-IR and low HOMA-B were independently and consistently associated with an increased diabetes risk in a multiethnic cohort of U.S. postmenopausal women. These data suggest the value of HOMA indexes for diabetes risk in epidemiologic studies.

Original languageEnglish (US)
Pages (from-to)1747-1752
Number of pages6
JournalDiabetes Care
Volume30
Issue number7
DOIs
StatePublished - Jul 1 2007
Externally publishedYes

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Women's Health
Observational Studies
Insulin Resistance
Homeostasis
Insulin
Fasting
Glucose
Hispanic Americans
Ethnic Groups
Case-Control Studies
Epidemiologic Studies

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Insulin sensitivity and insulin secretion determined by homeostasis model assessment and risk of diabetes in a multiethnic cohort of women : The women's health initiative observational study. / Song, Yiqing; Manson, Joann E.; Tinker, Lesley; Howard, Barbara V.; Kuller, Lewis H.; Nathan, Lauren; Rifai, Nader; Liu, Simin.

In: Diabetes Care, Vol. 30, No. 7, 01.07.2007, p. 1747-1752.

Research output: Contribution to journalArticle

Song, Yiqing ; Manson, Joann E. ; Tinker, Lesley ; Howard, Barbara V. ; Kuller, Lewis H. ; Nathan, Lauren ; Rifai, Nader ; Liu, Simin. / Insulin sensitivity and insulin secretion determined by homeostasis model assessment and risk of diabetes in a multiethnic cohort of women : The women's health initiative observational study. In: Diabetes Care. 2007 ; Vol. 30, No. 7. pp. 1747-1752.
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AU - Tinker, Lesley

AU - Howard, Barbara V.

AU - Kuller, Lewis H.

AU - Nathan, Lauren

AU - Rifai, Nader

AU - Liu, Simin

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