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Normal Range For Insulin Resistance Score? Done Fasting Blood Work. Does This Indicate I May Be Pre-diabetic?
Question: What is a normal range for the Insulin Resistance score (IR). The paper I have states that anyhting <=45 is normal. However, after my fasting bloodwork I discovered that my score was 44. Does this indicate that I may be pre-diabetic? Just how much over 45 can that go before any treatment or medication is warranted? I am not obese and no one in my biological family has diabetes. I do eat fruit (apples, bananas, honeydew, watermellon) and low-fat yogurt, as I have found these to be healthy alternatives to candy and other "junk" food. Should I take a Chromium supplement as a precaution?
Hi AAAA
Thanks for writing in.
I am a medical specialist with an additional degree in cardiology. I read your mail with diligence for 70% of cardiology patients I see treat have Diabetes Mellitus too. Some 15 years ago I did some research in State University of New York on insulin resistance and vascular dilation in humans. You are right of scoring IR value but taking holistic view of treating Diabetes and its complication we rely on Fasting Blood Sugar and glycated hemoglobin.
The concept of insulin resistance is relatively easy to understand, but determining precisely who is insulin resistant is more complicated. The relationship between glucose and insulin is quite complex and involves the interaction of many metabolic and regulatory factors. Normal insulin sensitivity varies widely and is influenced by age, ethnicity, and obesity. Simply put, not all people with impaired insulin sensitivity are necessarily suffering from a disorder
So related to practical approach to your main question I will quote from a recent article in Diabetic Care. I quote:
"HOMA-Estimated Insulin Resistance Is an Independent Predictor of Cardiovascular Disease in Type 2 Diabetic Subjects
Prospective data from the Verona Diabetes Complications Study
Enzo Bonora, MD, PHD, XXXXXXX Formentini, MD,
Francesco Calcaterra, MD,
et al from : From the Endocrinology and Metabolic Diseases, University of Verona Medical School, Verona, Italy
Abstract
OBJECTIVE—To evaluate whether homeostasis model assessment-estimated insulin resistance (HOMA-IR) is an independent predictor of cardiovascular disease (CVD) in type 2 diabetes.
RESEARCH DESIGN AND METHODS—Conventional CVD risk factors (sex, age, smoking, plasma lipids, blood pressure, and metabolic control) and insulin resistance (estimated by HOMA) were evaluated at baseline in 1,326 patients with type 2 diabetes examined within the Verona Diabetes Complications Study. At baseline and after a mean follow-up of 4.5 years, CVD was assessed by medical history, physical examination, electrocardiography, and echo-Doppler of carotid and lower limb arteries. Death certificates and medical records of subjects who died during the follow-up were carefully scrutinized to identify cardiovascular deaths. In statistical analyses, CVD was an aggregate end point including both fatal and nonfatal coronary, cerebrovascular, and peripheral vascular disease as well as ischemic electrocardiographic abnormalities and vascular lesions identified by echo-Doppler.
RESULTS—At baseline, 441 subjects were coded positive for CVD (prevalent cases). Incident cases numbered 126. Multiple logistic regression analyses showed that, along with sex, age, smoking, HDL/total cholesterol ratio, and hypertension, HOMA-IR was an independent predictor of both prevalent and incident CVD. A 1-unit increase in (log)HOMA-IR value was associated with an odds ratio for prevalent CVD at baseline of 1.31 (95% CI 1.10–1.56, P = 0.002) and for incident CVD during follow-up of 1.56 (95% CI 1.14–2.12, P < 0.001).
CONCLUSIONS—HOMA-IR is an independent predictor of CVD in type 2 diabetes. The improvement of insulin resistance might have beneficial effects not only on glucose control but also on CVD in patients with type 2 diabetes.
END OF QUOTE
Human beings are not digits so my suggestion with one value of IR less than <45 normal and more than it is abnormal. That does not diagnose you to be pre diabetic. Whenever we diagnose diabetic with at least two Fasting Blood Sugar and now one value of HBA1c we us those values for treatment goals where as you would known now with complexity of the above abstract we can not use IR (it is used for diagnosis Multiple Endocrinol Tumors or similar conditions but has little value in clinical practice either to diagnose or follow up a person who is suspected to have Diabetes Mellitus where genetic and environmental factors (body weight and height, diet and exercise) play a role. I wanted to be pragmatic in my answer you can ask a supplementary query I will be only too happy to answer as soon as possible. Good Luck.
Regards and best wishes. It is pleasure interacting with you.
Dr Anil Grover,
Medical Specialist & Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Thanks for writing in.
I am a medical specialist with an additional degree in cardiology. I read your mail with diligence for 70% of cardiology patients I see treat have Diabetes Mellitus too. Some 15 years ago I did some research in State University of New York on insulin resistance and vascular dilation in humans. You are right of scoring IR value but taking holistic view of treating Diabetes and its complication we rely on Fasting Blood Sugar and glycated hemoglobin.
The concept of insulin resistance is relatively easy to understand, but determining precisely who is insulin resistant is more complicated. The relationship between glucose and insulin is quite complex and involves the interaction of many metabolic and regulatory factors. Normal insulin sensitivity varies widely and is influenced by age, ethnicity, and obesity. Simply put, not all people with impaired insulin sensitivity are necessarily suffering from a disorder
So related to practical approach to your main question I will quote from a recent article in Diabetic Care. I quote:
"HOMA-Estimated Insulin Resistance Is an Independent Predictor of Cardiovascular Disease in Type 2 Diabetic Subjects
Prospective data from the Verona Diabetes Complications Study
Enzo Bonora, MD, PHD, XXXXXXX Formentini, MD,
Francesco Calcaterra, MD,
et al from : From the Endocrinology and Metabolic Diseases, University of Verona Medical School, Verona, Italy
Abstract
OBJECTIVE—To evaluate whether homeostasis model assessment-estimated insulin resistance (HOMA-IR) is an independent predictor of cardiovascular disease (CVD) in type 2 diabetes.
RESEARCH DESIGN AND METHODS—Conventional CVD risk factors (sex, age, smoking, plasma lipids, blood pressure, and metabolic control) and insulin resistance (estimated by HOMA) were evaluated at baseline in 1,326 patients with type 2 diabetes examined within the Verona Diabetes Complications Study. At baseline and after a mean follow-up of 4.5 years, CVD was assessed by medical history, physical examination, electrocardiography, and echo-Doppler of carotid and lower limb arteries. Death certificates and medical records of subjects who died during the follow-up were carefully scrutinized to identify cardiovascular deaths. In statistical analyses, CVD was an aggregate end point including both fatal and nonfatal coronary, cerebrovascular, and peripheral vascular disease as well as ischemic electrocardiographic abnormalities and vascular lesions identified by echo-Doppler.
RESULTS—At baseline, 441 subjects were coded positive for CVD (prevalent cases). Incident cases numbered 126. Multiple logistic regression analyses showed that, along with sex, age, smoking, HDL/total cholesterol ratio, and hypertension, HOMA-IR was an independent predictor of both prevalent and incident CVD. A 1-unit increase in (log)HOMA-IR value was associated with an odds ratio for prevalent CVD at baseline of 1.31 (95% CI 1.10–1.56, P = 0.002) and for incident CVD during follow-up of 1.56 (95% CI 1.14–2.12, P < 0.001).
CONCLUSIONS—HOMA-IR is an independent predictor of CVD in type 2 diabetes. The improvement of insulin resistance might have beneficial effects not only on glucose control but also on CVD in patients with type 2 diabetes.
END OF QUOTE
Human beings are not digits so my suggestion with one value of IR less than <45 normal and more than it is abnormal. That does not diagnose you to be pre diabetic. Whenever we diagnose diabetic with at least two Fasting Blood Sugar and now one value of HBA1c we us those values for treatment goals where as you would known now with complexity of the above abstract we can not use IR (it is used for diagnosis Multiple Endocrinol Tumors or similar conditions but has little value in clinical practice either to diagnose or follow up a person who is suspected to have Diabetes Mellitus where genetic and environmental factors (body weight and height, diet and exercise) play a role. I wanted to be pragmatic in my answer you can ask a supplementary query I will be only too happy to answer as soon as possible. Good Luck.
Regards and best wishes. It is pleasure interacting with you.
Dr Anil Grover,
Medical Specialist & Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
So, after controlling for other risk factors in your model such as smoking, sex, age, blood pressure and cholesterol readings, a 1 unit increase in the IR score led to greater log-odds of a CVD incident occurring (e^B=56% higher odds of CVD on follow-up). While highly significant (P<0.001). What was your -2 Log likelihood measure (hopefully it wasn't too high) and were the IV's added in a stepwise fashion to see how the significance tests hold out for each variable? I would imagine that all of those risk factors, when examined alone, would have a positive impact on the odds, but how are those odds regulated by other IV in the model? For instance, is the impact of the IR score on CVD event significantly different for smokers and non-smokers, or those with high LDL and low to moderate LDL? The reason I ask is that my father suffered from a early heart attack at age 42. He was a fairly heavy smoker (> 1 pack per day) and had been for as long as I could recall. So, do the effects of all these independent risk factors such as LDL, blood pressure, diabetes, and importantly age, differ on the odds of CVD for smokers and non-smokers? (ANCOVA)
Hi AAAAA
Thanks for your astute observation. That is why for the risk factors for coronary heart disease for what we know and there is so much we do not know. Specifically in relation to smoking, American Heart Association in 2001 year chose paper that proved smoking affects endothelium. But you would have seen, in my three decades of practice I have come across 75 years old willing to swear smoking does nothing but relax them. I assure you they are in minority. You have seen how difficult is to scientifically prove scientifically cause and effect relationship some times I want to believe what a the quote “Statistics are like a bikini. What they reveal is suggestive, but what they conceal is vital.” XXXXXXX Levenstein end of quote. I would never ask my prospective patient never to smoke while he can keep on enjoy some amount of alcohol. Both these statements tend do fairly intriguing in multiple logistics regression analysis if you were to prove cause and effect good or bad. I real life I go by this list of risk factors for my patients:
At any age, following is the list of risk factors for future development of Coronary Artery Disease. Let me enumerate and you can place yourself the risk you are carrying ('*' means you have the risk factor, '+/-' means I do not know and about others you know better):-
A: MODIFIABLE RISK FACTORS
Diabetes
Hypertension
Smoking
Stress
Obesity and Sedentary Life Style (Obesity alone is not a risk factor!)
High Bad Cholesterol and Lipid Components
Total Cholesterol above 190 mg%, LDL above 130 mg%, VLDL above 40 mg%,
Triglycerides above 150 mg%, Apolipoprotein B above reference value
Low Good Cholesterol and Lipid Component: +/-
Apolipoprotein a below reference range for the lab and
HDL below 40 mg% for man & and 50 mg% for woman
B: NON MODIFIABLE RISK FACTORS
Family History 0f Coronary Heart Disease
Increasing age
Being a Man (as opposed to women) till the age 45
Deficiency of Folic Acid leading to increase Homocysteine is considered risk factor in elderly. Vitamin E excellent lab result one non pharma company study (HPS) made us believe I quote : Vitamins and dietary supplements enrich pockets of those who manufacture them and urine of patients who take them. End of quote.
Asian Indians have high value of Lipoprotein small a, which acts force multiplier that is why India is unfortunately already facing diseases like Rheumatic heart disease (which is found in aboriginals living around XXXXXXX in your country) will become capital of cardiovascular disease of ischemic nature.
So, you see Medical Scientists have to cover a long distance from laboratory bench using crutches of statistics to patients bed side. I wish I could discuss with you more write to my personal id YYYY@YYYY . It was a pleasure. I thought I tried not be cynical about laboratory studies if I did, I apologize. It was pleasure interacting with you.
Dr Anil Grover,
Medical Specialist & Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Thanks for your astute observation. That is why for the risk factors for coronary heart disease for what we know and there is so much we do not know. Specifically in relation to smoking, American Heart Association in 2001 year chose paper that proved smoking affects endothelium. But you would have seen, in my three decades of practice I have come across 75 years old willing to swear smoking does nothing but relax them. I assure you they are in minority. You have seen how difficult is to scientifically prove scientifically cause and effect relationship some times I want to believe what a the quote “Statistics are like a bikini. What they reveal is suggestive, but what they conceal is vital.” XXXXXXX Levenstein end of quote. I would never ask my prospective patient never to smoke while he can keep on enjoy some amount of alcohol. Both these statements tend do fairly intriguing in multiple logistics regression analysis if you were to prove cause and effect good or bad. I real life I go by this list of risk factors for my patients:
At any age, following is the list of risk factors for future development of Coronary Artery Disease. Let me enumerate and you can place yourself the risk you are carrying ('*' means you have the risk factor, '+/-' means I do not know and about others you know better):-
A: MODIFIABLE RISK FACTORS
Diabetes
Hypertension
Smoking
Stress
Obesity and Sedentary Life Style (Obesity alone is not a risk factor!)
High Bad Cholesterol and Lipid Components
Total Cholesterol above 190 mg%, LDL above 130 mg%, VLDL above 40 mg%,
Triglycerides above 150 mg%, Apolipoprotein B above reference value
Low Good Cholesterol and Lipid Component: +/-
Apolipoprotein a below reference range for the lab and
HDL below 40 mg% for man & and 50 mg% for woman
B: NON MODIFIABLE RISK FACTORS
Family History 0f Coronary Heart Disease
Increasing age
Being a Man (as opposed to women) till the age 45
Deficiency of Folic Acid leading to increase Homocysteine is considered risk factor in elderly. Vitamin E excellent lab result one non pharma company study (HPS) made us believe I quote : Vitamins and dietary supplements enrich pockets of those who manufacture them and urine of patients who take them. End of quote.
Asian Indians have high value of Lipoprotein small a, which acts force multiplier that is why India is unfortunately already facing diseases like Rheumatic heart disease (which is found in aboriginals living around XXXXXXX in your country) will become capital of cardiovascular disease of ischemic nature.
So, you see Medical Scientists have to cover a long distance from laboratory bench using crutches of statistics to patients bed side. I wish I could discuss with you more write to my personal id YYYY@YYYY . It was a pleasure. I thought I tried not be cynical about laboratory studies if I did, I apologize. It was pleasure interacting with you.
Dr Anil Grover,
Medical Specialist & Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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