Insulin resistance measured by High Homeostasis Model Assessment (HOMA) as a Predictor for new onset Diabetes mellitus and diabetic Complications in Non-Diabetic Adults: A KoGES prospective Cohort Study

Abstract Aims: Homeostasis model assessment for insulin resistance (HOMA-IR) is a biomarker for Type 2 diabetes mellitus(T2DM). However, the role of HOMA-IR in the non-diabetic is unclear. Methods: From a prospective community-based cohort of 10,030 individuals, 4,314 individuals younger than 65 years and without diabetes were enrolled and divided into three groups by baseline HOMA-IR tertiles: high (n=1244), moderate (n=1248), and low (n=1822). The primary outcome was new onset T2DM. Secondary outcomes were chronic kidney disease (CKD) and a composite of coronary artery disease, myocardial infarction, and stroke as macrovascular events. Results:The mean age was 51 years. The prevalence of hypertension and cholesterol and HbA1c were higher in the high HOMA-IR group. New onset T2DM (6.3%) and CKD (12.2%) incidence in the high HOMA-IR group was higher than in the others. The prevalence of macrovascular events did not differ among groups. High-HOMA-IR was an independent risk factor for new onset T2DM (odds ratio 2.07 [1.32-3.25]; p =0.001) and CKD (1.42 [1.08-1.87]; p =0.01). Conclusions:High HOMA-IR was an early predictor of new onset T2DM and CKD regardless of the HbA1c in non-diabetic individuals. Further research on the specific cut off value will be needed.