Song Yiqing, Manson JoAnn E, Tinker Lesley, Howard Barbara V, Kuller Lewis H, Nathan Lauren, Rifai Nader, Liu Simin
Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Diabetes Care. 2007 Jul;30(7):1747-52. doi: 10.2337/dc07-0358. Epub 2007 Apr 27.
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 beta-cell function. However, prospective data regarding its relation to diabetes risk in ethnically diverse populations are limited.
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 beta-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.
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 > or = 126 mg/dl at baseline.
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.
基于空腹血糖和胰岛素血浆水平的稳态模型评估（HOMA）已得到广泛验证，并用于量化胰岛素抵抗和β细胞功能。然而，关于其在不同种族人群中与糖尿病风险关系的前瞻性数据有限。
在82069名年龄在50 - 79岁、无心血管疾病或糖尿病且参与妇女健康倡议观察性研究的女性中，我们进行了一项巢式病例对照研究，以前瞻性地研究胰岛素抵抗的HOMA（HOMA - IR）和β细胞功能（HOMA - B）与糖尿病风险的关系。在中位随访期5.9年期间，1584例糖尿病患者按年龄、种族、临床中心、采血时间和随访时间与2198名对照者进行匹配。
与对照者相比，病例组的空腹血糖、胰岛素和HOMA - IR的基线水平均显著更高，而HOMA - B更低（所有P值<0.0001）。在调整匹配因素和糖尿病风险因素后，所有这四个指标均与糖尿病风险显著相关；空腹血糖每增加1个标准差的估计相对风险为3.54（95%CI 3.02 - 4.13），空腹胰岛素为2.25（1.99 - 2.54），HOMA - IR为3.40（2.95 - 3.92），HOMA - B为0.57（0.51 - 0.63）。虽然在这些指标与种族之间未观察到具有统计学意义的相乘交互作用，但HOMA - IR和HOMA - B与糖尿病风险的关联在每个种族组中，包括白人、黑人、西班牙裔和亚裔/太平洋岛民中，仍然显著且稳健。当联合评估时，HOMA - IR和HOMA - B与糖尿病风险之间的关系似乎是独立且相加的。在排除基线时空腹血糖≥126mg/dl者后，HOMA - IR与风险增加的关联比其他指标更强。
在美国绝经后女性的多民族队列中，高HOMA - IR和低HOMA - B与糖尿病风险增加独立且持续相关。这些数据表明HOMA指数在流行病学研究中对糖尿病风险的价值。
