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Research · Lab markers

HOMA-IR

HOMA-IR is an index calculated from fasting insulin and fasting glucose. No diabetes body has endorsed a diagnostic cut point, and published ones run from 1.85 to 4.65, each set in a different population. Higher values go with more diabetes, high blood pressure and heart disease. The result shifts twofold with the insulin assay and varies 27% within a person.

Checked 2026-11-13
Status
Not a test in itself. It is an index calculated from a fasting insulin result and a fasting glucose result from the same blood draw. FDA classifies immunoreactive insulin test systems as class I devices exempt from premarket notification [1]. A joint laboratory guideline of the American Association for Clinical Chemistry and American Diabetes Association does not recommend routine insulin testing for most people with diabetes or at risk of it, and describes the assays as useful primarily for research [2]. An American Diabetes Association workgroup wrote in 2010 that there are no criteria by which a person could be classified as insulin sensitive or resistant [3].
Measures
An estimate of insulin resistance calculated as fasting insulin in µU/mL times fasting glucose in mg/dL, divided by 405. With glucose in mmol/L the divisor is 22.5 [4].
Also called
HOMA-IR, HOMA IR, HOMA, HOMA1-IR, HOMA2-IR, homeostasis model assessment of insulin resistance, homeostatic model assessment, homeostasis model assessment, insulin resistance index, insulin resistance score
Tested for
insulin resistance, prediabetes screening, metabolic health, weight gain, polycystic ovary syndrome, diabetes risk, heart disease risk, fatty liver

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Linked in research4

Reported risks0

No risks sourced yet.

Reference ranges

Each range is the one its source published, in index. Where sources differ, each is shown.

Bruneck Study, Italy, 1998

Adults aged 40 to 79, from a threshold set in non-obese people with no metabolic disorders · [5]

RangeWhat the source calls it
below 2.77 indexNo name given
2.77 or above index"insulin resistance"

A threshold chosen by the authors of one study, not a diagnostic cut point. No diabetes body has endorsed a diagnostic cut point for HOMA-IR: a joint laboratory guideline does not recommend routine insulin testing, and an American Diabetes Association workgroup states that no criteria exist for classing a person as insulin sensitive or resistant [2][3]. The figure is the lower limit of the top fifth of HOMA-IR in 225 non-obese people with no metabolic disorders, so one in five of that group sits at or above it by construction. By this threshold, 9.6% of the whole study population was insulin resistant with no glucose, lipid, uric acid or blood pressure disorder [5].

Decision rule fitted to insulin clamp results, Stern and colleagues, 2005, body mass index of 27.5 or below

Adults with a body mass index of 27.5 kg/m2 or below · [6]

RangeWhat the source calls it
4.65 or below indexNo name given
above 4.65 index"insulin resistance"

A decision rule from one study, not a diagnostic cut point, and no diabetes body has endorsed one [2][3]. The rule was fitted to clamp measurements in 2,321 people in Europe and the US. It diagnoses insulin resistance when body mass index is above 28.9, or HOMA-IR is above 4.65, or body mass index is above 27.5 and HOMA-IR is above 3.60. It had a sensitivity of 84.9% and a specificity of 78.7%. The authors note that 4.65 corresponded to a fasting insulin of 20.7 µU/mL [6].

Decision rule fitted to insulin clamp results, Stern and colleagues, 2005, body mass index above 27.5 and up to 28.9

Adults with a body mass index above 27.5 and up to 28.9 kg/m2 · [6]

RangeWhat the source calls it
3.6 or below indexNo name given
above 3.6 index"insulin resistance"

The same decision rule, which is not a diagnostic cut point [2][3]. Above a body mass index of 28.9 the rule classes a person as insulin resistant whatever the HOMA-IR, so it gives no HOMA-IR figure for that group. The authors note that 3.60 corresponded to a fasting insulin of 16.3 µU/mL [6].

Spanish population study of cut-off values fitted to the metabolic syndrome, 2013, men

Men aged 20 and older without diabetes, in a random sample of the Spanish population, with insulin measured by radioimmunoassay · [7]

RangeWhat the source calls it
below 1.85 indexNo name given
1.85 or above index"insulin resistance"

A cut-off proposed by one study, not a diagnostic cut point, and no diabetes body has endorsed one [2][3]. It is the value that most accurately separated men with and without the metabolic syndrome by the Adult Treatment Panel III definition (sensitivity 0.78, specificity 0.57). With the International Diabetes Federation definition the figure was 2.05. The paper prints the cut-off as a single figure and does not say on which side a result equal to it falls. In women without diabetes the fitted cut-off changed with age, 2.36 at age 30, 2.07 at 50 and 2.47 at 70, so this page carries no single range for women from this source. The authors contrast these figures with 3.46, the 90th percentile in the same population [7].

Definition used in a US national survey analysis, 2025

US adults aged 20 and older without diabetes, excluding pregnant women, as a research definition · [8]

RangeWhat the source calls it
2.6 or below indexNo name given
above 2.6 index"insulin resistance"

A definition chosen by the authors of one study to track trends, not a diagnostic cut point, and no diabetes body has endorsed one [2][3]. It is the 66.7th percentile of HOMA-IR in the surveyed population, so the upper third is labeled insulin resistant by construction. By this definition the age-standardized share of US adults without diabetes with insulin resistance rose from 24.8% in 1999 to 2000 to 38.4% in 2017 to 2018. The survey changed insulin assays over the years, and the authors adjusted results to one method [8].

Reference values in healthy Iranian adults, Tehran Lipid and Glucose Study, 2014

Non-obese healthy adults aged 24 to 83, with insulin measured by electrochemiluminescence immunoassay · [9]

RangeWhat the source calls it
below 0.63 indexNo name given
0.63 to 2.68 index"reference values"
above 2.68 indexNo name given

A reference interval from one study, not a diagnostic cut point, and no diabetes body has endorsed one [2][3]. It is the central 95% of results in 309 people selected as healthy and non-obese (124 men and 185 women), so 1 in 20 such people falls outside it. The same study gives 0.40 to 1.80 for HOMA2-IR, a computer-model version of the index that is a different calculation and is not placed on this scale [9].

Reference interval from a Brazilian laboratory database, 2024

Adults aged 20 to 60, both sexes, with insulin measured by electrochemiluminescence immunoassay · [10]

RangeWhat the source calls it
below 0.39 indexNo name given
0.39 to 2.86 index"reference interval"
above 2.86 indexNo name given

A reference interval from one study, not a diagnostic cut point, and no diabetes body has endorsed one [2][3]. It was estimated by a statistical method from the stored results of 21,684 people in Rio de Janeiro after exclusions, 86% of them women, not from people examined and found healthy. The intervals were 0.39 to 2.86 in women and 0.38 to 2.81 in men, and the authors found sex-specific intervals not justified. They describe their upper limit as relatively higher than in other studies [10].

What has been shown to move it

Shown to lower it18

BerberineStrong

Blood sugar in type 2 diabetes

Shown to lower fasting glucose and HbA1c in adults with type 2 diabetes, with HbA1c about 0.6 points lower. Many trials were small and low quality.

Against placebo in 20 trials (1,761 participants), it lowered fasting glucose by 0.52 mmol/L (95% CI -0.72 to -0.33) and HOMA-IR by 0.85.

The numbers and sources
Effect
Across 37 trials (3,048 patients), berberine lowered fasting glucose by 0.82 mmol/L (95% CI -0.95 to -0.70), HbA1c by 0.63% (95% CI -0.72 to -0.53) and 2-hour glucose by 1.16 mmol/L, with larger effects at higher baseline glucose [1]. Against placebo in 20 trials (1,761 participants), it lowered fasting glucose by 0.52 mmol/L (95% CI -0.72 to -0.33) and HOMA-IR by 0.85 [2].
Population
Adults with type 2 diabetes [1]. Adults with and without diabetes [2].
Sources
[1], [2]
Caveats
Effects on fasting glucose were larger in people with diabetes and in Asian participants [2]. Many trials were small and of low methodological quality [3].
Keto dietStrongStudied in women

Weight and insulin resistance in PCOS

Shown in pooled studies to lower weight and insulin resistance in women with PCOS. Against other diets, the reviews disagreed on weight.

Compared with other diets [21]; low-calorie diets [22]; before the diet, in the same women [21][22][23]

In 2 RCTs against low-calorie diets, body weight did not differ significantly, while BMI, fat mass, glucose and HOMA-IR fell more on the ketogenic diets.

The numbers and sources
Effect
Against other diets, ketogenic diets lowered weight 4.98 kg more (95% CI 0.91 to 9.05), BMI 1.65 kg/m2 more and insulin resistance more (MD -1.71, 95% CI -2.98 to -0.43, I² 90%). From before to after the diet, weight fell 10.77 kg and BMI 3.38 kg/m2 [21]. In 2 RCTs against low-calorie diets, body weight did not differ significantly, while BMI, fat mass, glucose and HOMA-IR fell more on the ketogenic diets [22]. A third review of 7 studies found weight, BMI, glucose, insulin, HOMA-IR, LDL cholesterol and triglycerides fell from before to after the diet [23].
Population
Women with PCOS, most with BMI above 25, in 15 studies, 10 pooled [21]; 10 studies including 3 RCTs, 4 cohorts and 2 case series [22]; 7 studies [23].
Sources
[21], [22], [23]
Caveats
Heterogeneity was high for most outcomes [21]. Before-and-after results cannot separate the diet from weight loss or time. A published letter disputed whether the definition of real-world exposure in [21] matched its inclusion criteria [24].
OrlistatStrong

Liver enzymes in fatty liver disease

Shown to lower liver enzymes in fatty liver disease, ALT by about 9 U/L. Liver fat and scarring were not measured.

LDL cholesterol fell 5.61 mg/dL, fasting glucose 4.05 mg/dL, HOMA-IR 0.70 and BMI 0.99 kg/m².

The numbers and sources
Effect
In people with metabolic dysfunction-associated steatotic liver disease, orlistat lowered AST by 4.01 U/L (95% CI 1.97 to 6.05), ALT by 8.70 U/L (95% CI 0.90 to 16.51) and GGT by 7.74 U/L (95% CI 0.59 to 14.88) against control. LDL cholesterol fell 5.61 mg/dL, fasting glucose 4.05 mg/dL, HOMA-IR 0.70 and BMI 0.99 kg/m². Blood pressure did not change [6]. A second meta-analysis also found lower ALT, AST, HOMA-IR, BMI, cholesterol, insulin and waist circumference [7].
Population
6 RCTs [6]; 11 studies with 582 participants [7].
Sources
[6], [7]
Caveats
Both reviews measured blood markers, not liver fat on imaging or scarring on biopsy. The trials were small and likely overlap between the reviews. The abstract of [7] does not say whether all 11 studies were randomized.
TurmericStrong

Blood sugar

Shown to lower fasting glucose about 6 to 10 mg/dL and HbA1c about 0.3 points in adults with prediabetes or type 2 diabetes.

The numbers and sources
Effect
Across 34 RCTs in adults with prediabetes or type 2 diabetes, curcumin or turmeric lowered fasting glucose by 10.15 mg/dL (95% CI -12.59 to -7.72), HbA1c by 0.32% (95% CI -0.43 to -0.21) and HOMA-IR by 0.46 against control [6]. A meta-analysis of 63 trials drawn from 13 earlier reviews (3,706 participants) found fasting glucose 6.30 mg/dL lower (95% CI -9.33 to -3.27) and HbA1c 0.31% lower (95% CI -0.57 to -0.05) [7]. With piperine added, 15 RCTs (1,020 participants) showed fasting glucose 5.89 mg/dL lower, while HbA1c, fasting insulin and HOMA-IR did not differ significantly [8].
Population
Adults with prediabetes or type 2 diabetes [6][7]; adults, many overweight with metabolic disorders [8].
Sources
[6], [7], [8], [9]
Caveats
Heterogeneity was significant [6] and high [7]. GRADE certainty was low for fasting glucose and HbA1c in the piperine review [8]. In a network meta-analysis of 24 RCTs in prediabetes, turmeric extract was linked to fewer new cases of type 2 diabetes (RR 0.05, 95% CI 0.00 to 0.78), with low certainty and short trials [9].
Alpha-lipoic acidModerate

Blood sugar

Mixed results: one large review found lower fasting glucose and HbA1c, while a review of overweight adults and neuropathy trials found no change.

The numbers and sources
Effect
Across 63 trials, fasting glucose fell 5.28 mg/dL (95% CI -7.21 to -3.35), HbA1c 0.40% (95% CI -0.66 to -0.14), fasting insulin 1.70 mU/mL and HOMA-IR 0.74 against control [8]. In 11 trials of 704 overweight or obese adults, fasting glucose (SMD 0.13, 95% CI -0.16 to 0.41) and HOMA-IR (SMD -0.23, 95% CI -0.60 to 0.15) did not differ from control [9]. In diabetic neuropathy trials, HbA1c did not change [5].
Population
63 randomized trials [8]; adults with a BMI of 25 or more [9]; people with diabetic neuropathy [5].
Sources
[8], [9], [5]
Caveats
The reviews disagree. The overweight review rated 8 of its 11 trials at low risk of bias [9].
ChromiumModerateStudied in women

Insulin resistance

Shown to lower HOMA-IR and fasting insulin slightly in overweight adults and women with PCOS. Fasting glucose and HbA1c did not change significantly.

Against metformin, HOMA-IR fell more on chromium (p < 0.00001).

The numbers and sources
Effect
In 20 trials in overweight and obese adults, HOMA-IR fell 0.26 (95% CI -0.48 to -0.03) and fasting insulin 12.55 pmol/L (95% CI -23.62 to -1.47). Fasting glucose (-1.60 mg/dL, 95% CI -3.28 to 0.07) and HbA1c (-0.05 points, 95% CI -0.19 to 0.07) did not change significantly [6]. In 10 RCTs in 683 women with polycystic ovary syndrome, chromium lowered fasting insulin (p 0.01) and raised the insulin sensitivity index QUICKI (p 0.02) against placebo. Against metformin, HOMA-IR fell more on chromium (p < 0.00001) [7].
Population
Overweight and obese adults, with trial sizes of 1 to 137 [6]; women with polycystic ovary syndrome [7].
Sources
[6], [7]
Caveats
The two reviews studied different populations. The PCOS abstract gives p-values without effect sizes [7]. The overweight analysis abstract calls the fasting glucose fall significant though its interval crosses zero [6]. In 2005 FDA ranked the evidence for chromium picolinate and insulin resistance at its lowest level for a qualified claim [5].
Dark chocolateModerate

Blood vessel function and insulin resistance

Shown to improve blood vessel widening and lower insulin resistance in short trials of chocolate or cocoa, in one meta-analysis rated low to moderate quality.

Compared with control conditions the abstract does not describe [3]

HOMA-IR fell 0.67 (95% CI 0.36 to 0.98) through lower serum insulin.

The numbers and sources
Effect
Flow-mediated dilation rose 1.34% (95% CI 1.00 to 1.68) with regular intake and 3.19% after a single dose. HOMA-IR fell 0.67 (95% CI 0.36 to 0.98) through lower serum insulin. Changes in LDL cholesterol (-0.07 mmol/L, 95% CI -0.13 to 0.00) and HDL cholesterol were of borderline significance [3].
Population
1,297 participants in 42 trials of up to 18 weeks [3].
Sources
[3]
Caveats
The authors rated the evidence low to moderate quality and called for larger, longer, independently funded trials [3].
Fermented foodsModerate

Blood sugar

Shown to lower fasting glucose slightly with kimchi and kefir, in two meta-analyses. Probiotic yogurt did not differ from ordinary yogurt.

Compared with control groups the abstract does not describe [7][9]; conventional yogurt [10]

The numbers and sources
Effect
Kefir lowered fasting glucose (MD -8.46 mg/dL) and HOMA-IR (MD -1.71) [7]. Fermented kimchi lowered fasting glucose (WMD -1.93 mg/dL, 95% CI -3.82 to -0.03) [9]. Probiotic yogurt did not change HbA1c, fasting glucose, fasting insulin or HOMA-IR against mostly conventional yogurt in people with type 2 diabetes or obesity [10].
Population
24 studies of kefir [7]. 205 participants in 5 kimchi trials [9]. 472 people with type 2 diabetes or obesity in 9 trials [10].
Sources
[7], [9], [10]
Caveats
Small trials of single foods. The yogurt review compared two fermented foods with each other, not fermented food with none [10].
InositolModerate

Weight, blood sugar and lipids

Shown to lower BMI slightly, about 0.6 kg/m², and glucose, triglycerides and blood pressure in adults across several conditions, at low certainty for some.

The numbers and sources
Effect
In 18 RCTs (898 participants) of at least 4 weeks, inositol lowered BMI by 0.57 kg/m² (95% CI -1.10 to -0.03), waist circumference by 2.36 cm, glucose by 7.25 mg/dL, HOMA-IR by 1.21, triglycerides by 29.80 mg/dL, LDL cholesterol by 5.15 mg/dL, and systolic and diastolic pressure by 5.34 and 6.12 mm Hg [11].
Population
Adults in RCTs across several conditions [11].
Sources
[11]
Caveats
Certainty was low to very low for BMI, waist and blood pressure, and moderate for glucose, insulin and HOMA-IR. Heterogeneity was high for most outcomes, and the authors note a high risk of bias in the trials [11].
Intermittent fastingModerate

Blood sugar

Shown to lower fasting glucose slightly in adults with prediabetes or type 2 diabetes, while HbA1c did not change overall in pooled trials.

Compared with a control diet with no time restriction [10]; unrestricted eating [11]; daily calorie restriction or a control group [12]; standard-of-care nutritional counseling alone [13]

In adults without diabetes, time-restricted eating without calorie restriction lowered fasting glucose by 2.65 mg/dL (95% CI -3.92 to -1.39) and HOMA-IR by 0.58.

The numbers and sources
Effect
In 10 trials with 599 participants, HbA1c changed by -0.30 percentage points (95% CI -0.63 to 0.02, p 0.06, moderate certainty), by -0.09 points in prediabetes and by -0.43 points in type 2 diabetes (95% CI -0.92 to 0.07). Fasting glucose fell 0.30 mmol/L (95% CI -0.53 to -0.07, moderate certainty) [10]. In adults without diabetes, time-restricted eating without calorie restriction lowered fasting glucose by 2.65 mg/dL (95% CI -3.92 to -1.39) and HOMA-IR by 0.58 [11]. In type 2 diabetes, HbA1c fell 0.91% on an 8-hour window and 0.94% on calorie restriction against control, with no difference between the two [12]. In metabolic syndrome, an 8 to 10 hour window lowered HbA1c by 0.10% (95% CI -0.19% to -0.003%) against standard care [13].
Population
Adults with prediabetes or type 2 diabetes, trials averaging 4 months with 4 to 10 hour windows [10]; 11 trials with 653 adults without diabetes [11]; 75 adults with obesity and type 2 diabetes over 6 months [12]; 108 adults with metabolic syndrome over 3 months [13].
Sources
[10], [11], [12], [13]
Caveats
Wide confidence intervals and small trials limited the pooled evidence, and effects on insulin sensitivity and continuous glucose monitoring were inconclusive [10]. Three authors of [10] work at a hospital partly funded by the Novo Nordisk Foundation.
Low-carb dietModerateStudied in women

Weight and insulin resistance in PCOS

Shown in one meta-analysis of 8 trials to lower BMI and insulin resistance more than a regular diet in women with PCOS.

Compared with a regular diet with about 45% of energy from carbohydrate [13]; before the diet, in the same women [14]

The numbers and sources
Effect
Against a regular diet, low-carbohydrate diets lowered BMI (SMD -1.04, 95% CI -1.38 to -0.70), HOMA-IR (SMD -0.66, 95% CI -1.01 to -0.30), total cholesterol (SMD -0.68) and LDL cholesterol (SMD -0.66, 95% CI -1.30 to -0.02) [13]. A second review of 25 diet studies in PCOS found insulin resistance fell from before to after diets with under 50% of energy from carbohydrate (standardized paired difference -0.86, 95% CI -1.23 to -0.50) [14].
Population
327 women with PCOS in 8 RCTs [13]; women with PCOS in 25 prospective diet studies [14].
Sources
[13], [14]
Caveats
Trials were small. The second review measured change within each diet group rather than against another diet [14].
MagnesiumModerate

Blood sugar and insulin resistance

Mixed results: most reviews found lower insulin resistance but disagreed on fasting glucose, and one review in people with diabetes found no significant change.

The numbers and sources
Effect
One meta-analysis found magnesium lowered HOMA-IR (WMD -0.67, 95% CI -1.20 to -0.14) but not fasting glucose (WMD -0.20 mmol/L, 95% CI -0.45 to 0.05) or HbA1c overall. Trials of 4 months or longer showed lower fasting glucose and HOMA-IR [3]. A 2021 meta-analysis of double-blind trials reported lower fasting glucose in people with diabetes and improved glucose and insulin-sensitivity markers in people at high risk [4]. A 2026 meta-analysis of 78 RCTs found lower HOMA-IR (WMD -0.48, 95% CI -0.79 to -0.18), fasting glucose (WMD -3.60 mg/dL) and HbA1c (WMD -0.15%) [5]. A 2026 meta-analysis of 15 RCTs (1,085 people with diabetes or prediabetes) found no significant change in insulin (MD -1.73) or HOMA-IR (MD -0.74, 95% CI -1.58 to 0.09). Baseline insulin and HOMA-IR modified the effect [6].
Population
People with and without diabetes [3][5]; people with or at high risk of diabetes [4][6].
Sources
[3], [4], [5], [6]
Caveats
The sources disagree on fasting glucose and on HOMA-IR in people with diabetes. The 2021 abstract does not report effect sizes [4]. The authors of [5] rated certainty as variable across outcomes.
Milk thistleModerate

Blood sugar in type 2 diabetes

Shown to lower fasting glucose about 27 mg/dL and HbA1c about 1 point in adults with type 2 diabetes, in low quality trials.

A 2025 network meta-analysis of 17 studies (1,337 people with type 2 diabetes) found silymarin lowered fasting glucose, HOMA-IR and HbA1c against placebo (P < 0.05).

The numbers and sources
Effect
In 5 trials (270 patients), silymarin lowered fasting blood glucose by 26.86 mg/dL (95% CI -35.42 to -18.30) and HbA1c by 1.07 points (95% CI -1.73 to -0.40). Lipids did not change [9]. A 2025 network meta-analysis of 17 studies (1,337 people with type 2 diabetes) found silymarin lowered fasting glucose, HOMA-IR and HbA1c against placebo (P < 0.05) [10]. Across 6 RCTs (673 participants), HOMA-IR fell by 2.29 (95% CI -4.55 to -0.03) with no change in fasting insulin. The fall was seen in type 2 diabetes but not in fatty liver disease [11].
Population
Adults with type 2 diabetes [9][10]; adults with type 2 diabetes, alcoholic cirrhosis or fatty liver disease in Iran, Egypt and Italy [11].
Sources
[9], [10], [11]
Caveats
The authors of [9] rated the evidence as low quality, with high heterogeneity. The network meta-analysis abstract reports p-values for silymarin against placebo without effect sizes [10]. The authors of [11] called the evidence limited.
Nordic dietModerate

Blood sugar and insulin

Mixed results: fasting glucose did not change in adults, while fasting insulin and insulin resistance fell slightly.

Compared with an average Nordic diet with the same calories [4]; control diets the source does not describe [7]

The numbers and sources
Effect
In 6 RCTs (618 participants, 6 to 26 weeks), fasting glucose did not change (-0.05 mmol/L, 95% CI -0.13 to 0.01), while fasting insulin fell 1.12 mU/L and HOMA-IR 0.34 against control diets. The insulin result depended on one study [7]. Insulin sensitivity did not change in SYSDIET [4].
Population
Adults in Nordic countries with cardiometabolic risk factors [4][7].
Sources
[4], [7]
Caveats
Two-hour glucose and the Matsuda index did not change [7].
Physical activityModerateStudied in women

Insulin resistance and weight in PCOS, in trials

Shown in trials to lower fasting insulin and insulin resistance slightly in women with PCOS. Fasting glucose did not change, at very low to low quality.

Compared with usual care or control groups [27]; before exercise, including trials with no control group [28]

Vigorous exercise was linked to a 36.2% fall in HOMA-IR, a 4.2% fall in waist circumference and a 24.2% rise in VO2peak.

The numbers and sources
Effect
Against control, exercise lowered fasting insulin (MD -2.44 µIU/mL, 95% CI -4.24 to -0.64) and HOMA-IR (MD -0.57, 95% CI -0.99 to -0.14), both very low quality, and LDL cholesterol and triglycerides. Waist fell 2.62 cm and BMI 1.02 kg/m2 after the programs. Fasting glucose and blood pressure did not change. Exercise added to diet did not differ from diet alone [27]. Vigorous exercise was linked to a 36.2% fall in HOMA-IR, a 4.2% fall in waist circumference and a 24.2% rise in VO2peak [28].
Population
18 trials in women with PCOS [27]; 777 women in 19 studies, including uncontrolled trials, of 6 to 26 weeks [28].
Sources
[27], [28]
Caveats
Many effects were modest with wide intervals and shifted when single trials were added or removed [27]. [28] pooled controlled and uncontrolled studies.
Red light therapyModerate

Weight and waist size in obesity

Shown to reduce waist size, weight and BMI in people with obesity in one meta-analysis of 11 trials. Body fat percentage did not change.

The numbers and sources
Effect
Across 11 RCTs (569 patients), photobiomodulation improved waistline (mean difference -7.28, 95% CI -9.97 to -5.67), weight (-3.54, 95% CI -5.97 to -1.11) and BMI (-1.18, 95% CI -1.93 to -0.43), and lowered C-reactive protein, total cholesterol and HOMA-IR. Fat mass percentage (-0.28, 95% CI -1.25 to 0.69), waist-to-hip ratio and insulin did not differ [14].
Population
569 people with obesity in 11 RCTs with varied comparators, including exercise, diet and sham light [14].
Sources
[14]
Caveats
The abstract does not give units for the mean differences. Comparators varied, and the measure of body fat itself did not change. The authors call for larger multi-center trials with longer follow-up [14].
YogaModerateStudied in women

Cycles, androgens and blood sugar in PCOS

Shown in one small meta-analysis to lower menstrual irregularity, signs of excess androgens, fasting glucose and insulin resistance in women with PCOS, at low strength of evidence.

Compared with controls the source abstract does not describe [21]; conventional physical activity, routine care or no intervention [22]

The numbers and sources
Effect
Pooling 2 RCTs, yoga lowered menstrual irregularity (MD -0.41, 95% CI -0.74 to -0.08), clinical hyperandrogenism (MD -0.70, 95% CI -1.15 to -0.26), fasting glucose (MD -0.22 mmol/L, 95% CI -0.44 to -0.01), fasting insulin (MD -28.21 pmol/L, 95% CI -43.79 to -12.63) and HOMA-IR (MD -0.86, 95% CI -1.29 to -0.43) [21]. A 2026 review of trials with 258 participants found fasting glucose fell 4.50 mg/dL more than in controls in one trial (95% CI 2.39 to 6.61) and did not differ significantly in another. In one trial, testosterone did not change significantly and LH fell [22].
Population
515 women with PCOS in 11 studies, 2 RCTs pooled [21]; 258 women with PCOS in RCTs [22].
Sources
[21], [22]
Caveats
The authors of [21] rated the strength of evidence low. [22] could not pool its trials, and three of its five reports came from one trial.
ZincModerate

Blood sugar

Shown to lower fasting glucose about 14 mg/dL and HbA1c about 0.55% in people with and without diabetes.

Across 18 RCTs (1,023 participants) with diabetes, gestational diabetes or prediabetes, zinc lowered serum insulin (MD -2.50, 95% CI -4.69 to -0.31) and HOMA-IR (MD -1.10, 95% CI -2.05 to -0.15), and LDL cholesterol rose slightly (MD 3.46, 95% CI 1.48 to 5.43).

The numbers and sources
Effect
Across 32 placebo-controlled interventions (1,700 participants, 14 countries), zinc lowered fasting glucose by 14.15 mg/dL (95% CI -17.36 to -10.93), 2-hour glucose by 36.85 mg/dL, HbA1c by 0.55% (95% CI -0.84 to -0.27) and hs-CRP by 1.31 mg/L [3]. Across 18 RCTs (1,023 participants) with diabetes, gestational diabetes or prediabetes, zinc lowered serum insulin (MD -2.50, 95% CI -4.69 to -0.31) and HOMA-IR (MD -1.10, 95% CI -2.05 to -0.15), and LDL cholesterol rose slightly (MD 3.46, 95% CI 1.48 to 5.43) [4].
Population
People with and without diabetes [3]; people with diabetes or prediabetes [4].
Sources
[3], [4]
Caveats
The fasting glucose effect depended on diabetes status and on the zinc formulation [3].

Shown to raise it2

Sleep durationModerateHow often is not known

Lower insulin sensitivity with short sleep

Shown to lower insulin sensitivity when sleep was restricted, in a meta-analysis of randomized trials, measured by glucose tolerance tests, HOMA-IR and the clamp.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Across 21 pooled sleep restriction studies, insulin sensitivity fell when measured by oral or intravenous glucose tolerance tests and by the homeostatic model assessment of insulin resistance (HOMA-IR). Whole-body insulin sensitivity measured by the hyperinsulinemic euglycemic clamp also fell. Peripheral insulin sensitivity did not change [13].
Population
35 randomized controlled trials, 26 of sleep restriction and 21 of these pooled [13].
Sources
[13]
Caveats
Short laboratory trials. The abstract gives no pooled effect sizes. A fall in insulin sensitivity over days does not show that habitual short sleep causes diabetes.
Light at nightLimitedHow often is not known

Room light during sleep raised next-morning insulin resistance

One small trial found a single night of sleeping in room light raised next-morning insulin resistance by about 15% and night heart rate, against sleeping in dim light.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
After one night with overhead room light at 100 lux, HOMA-IR rose about 15%, against a 4% fall after a second dim night (p = 0.018). Early insulin response to a glucose drink rose, heart rate during sleep was higher and heart rate variability lower. Melatonin levels did not differ [11].
Population
20 young adults randomized to room light (n = 10) or dim light under 3 lux (n = 10) in a sleep laboratory [11].
Sources
[11]
Caveats
One night, 20 people. Glucose levels stayed similar in both groups, and whether repeated nights change health was not tested [11].

Studies disagree1

MetforminStrongStudied in women

Insulin resistance and blood sugar in PCOS

Shown to lower insulin resistance and fasting glucose slightly against placebo in women with PCOS. Added to lifestyle change, one review found no extra effect.

Compared with placebo [34][31]; lifestyle change with or without placebo [33]; combined oral contraceptive pills [35]

The numbers and sources
Effect
Against placebo, metformin lowered HOMA-IR by 0.50 (95% CI 0.09 to 0.91) and fasting glucose by 0.13 mmol/L (95% CI 0.07 to 0.19), both moderate certainty [34]. A second review also found lower fasting glucose than placebo (SMD -0.23, 95% CI -0.40 to -0.06) [31]. Lifestyle change plus metformin did not differ from lifestyle change with or without placebo on surrogate markers of insulin resistance or fasting glucose after 6 months [33]. Against combined oral contraceptive pills, metformin lowered insulin by 27.12 pmol/L (95% CI 13.59 to 40.65) [35].
Population
RCTs in women with PCOS published through July 2022 [34]; 24 RCTs with 564 women given metformin [31]; 12 RCTs with 608 women [33]; 36 RCTs in women with PCOS [35].
Sources
[34], [31], [33], [35]
Caveats
The changes are small. The add-on comparison rests on small, short trials [33].

Tested, and not shown to change it10

Apple cider vinegarStrong

Blood sugar

Shown to lower fasting blood sugar and HbA1c in adults with type 2 diabetes. In apparently healthy participants, fasting glucose rose instead.

The numbers and sources
Effect
In 7 controlled trials in type 2 diabetes, ACV lowered fasting blood sugar by 21.9 mg/dL (95% CI -29.19 to -14.67) and HbA1c by 1.53 (95% CI -2.65 to -0.41), with no change in HOMA-IR [1]. Across 9 studies in adults, ACV lowered fasting glucose by 7.97 mg/dL (95% CI -13.74 to -2.21) and HbA1c by 0.50 (95% CI -0.90 to -0.09), with no change in fasting insulin or HOMA-IR [2]. A review of 6 studies in 317 people with type 2 diabetes found lower fasting glucose and HbA1c with vinegar [3].
Population
Adults with type 2 diabetes [1][3]. Adults with and without diabetes [2].
Sources
[1], [2], [3]
Caveats
Heterogeneity for HbA1c was high (I² 91%) [2]. Vinegar content varied across studies and samples were small [3]. In apparently healthy participants, fasting glucose rose [2].
FenugreekStrong

Blood sugar in diabetes

Shown to lower fasting glucose by about 1 mmol/L and HbA1c by about 0.85% in people with diabetes, only at medium or high doses.

A 2023 meta-analysis of 10 RCTs (706 participants) with type 2 diabetes or prediabetes also reported lower fasting glucose, 2-hour glucose and HbA1c, and no change in HOMA-IR.

The numbers and sources
Effect
Across 10 trials, fenugreek seed changed fasting glucose by -0.96 mmol/L (95% CI -1.52 to -0.40, I² 80%), 2-hour glucose by -2.19 mmol/L and HbA1c by -0.85% (95% CI -1.49 to -0.22, 3 trials). Significant effects appeared only at medium or high doses in people with diabetes [1]. A 2023 meta-analysis of 10 RCTs (706 participants) with type 2 diabetes or prediabetes also reported lower fasting glucose, 2-hour glucose and HbA1c, and no change in HOMA-IR [2].
Population
People with and without diabetes [1]; type 2 diabetes and prediabetes [2].
Sources
[1], [2]
Caveats
Most trials in [1] were of low methodological quality. The 2023 abstract does not report effect sizes [2].
Alternate-day fastingModerate

Blood sugar in people without diabetes

Not shown to change fasting glucose or insulin resistance against control or daily calorie restriction in adults without diabetes.

Compared with eating every day, with no fasting days or daily fasting window

The numbers and sources
Effect
Fasting glucose (p 0.09) and HOMA-IR (p 0.55) did not differ from control [2]. Fasting glucose, fasting insulin and insulin resistance did not differ from daily calorie restriction at 6 or 12 months [3]. HbA1c did not differ between intermittent fasting, continuous restriction and unrestricted diets [6].
Population
269 adults [2]; 100 adults with obesity [3]; 99 trials [6].
Sources
[2], [3], [6]
Caveats
Few participants had diabetes in these trials.
AstaxanthinModerate

Blood sugar and blood lipids

Shown to lower fasting glucose by about 16 mg/dL and triglycerides in people with prediabetes or type 2 diabetes. Reviews disagree on LDL and total cholesterol.

HOMA-IR, weight and BMI did not change.

The numbers and sources
Effect
In prediabetes and type 2 diabetes, astaxanthin lowered fasting glucose by 16.1 mg/dL (95% CI -29.0 to -3.3), HbA1c by 0.34 points, triglycerides by 20.9 mg/dL, total cholesterol by 12.2 mg/dL and LDL by 9.4 mg/dL, and raised HDL by 3.0 mg/dL. HOMA-IR, weight and BMI did not change [4]. At 6 to 20 mg a day, a second meta-analysis found higher HDL and lower triglycerides, with no change in LDL or total cholesterol [5]. In adults at risk of metabolic syndrome, effects on total cholesterol and systolic pressure were marginal, and LDL fell [6].
Population
403 patients in 9 RCTs [4]; 8 studies with 11 results [5]; 321 adults in 7 RCTs [6].
Sources
[4], [5], [6]
Caveats
The reviews disagree on LDL and total cholesterol. All pooled small trials.
GarlicModerate

Blood sugar

Shown to lower fasting glucose, and HbA1c by about 0.5 points, more in people with type 2 diabetes. Insulin did not change.

Insulin and HOMA-IR did not change significantly.

The numbers and sources
Effect
In 9 RCTs (768 patients with type 2 diabetes), fasting glucose was lower with garlic at 1 to 2, 3 to 4, 12 and 24 weeks. Fructosamine and HbA1c were lower at 12 and 24 weeks. Complications did not differ [5]. A 2026 GRADE-assessed meta-analysis of 27 RCTs (1,619 adults) found fasting glucose fell 2.76 mg/dL (95% CI -5.11 to -0.41) and HbA1c 0.53 percentage points (95% CI -0.86 to -0.20). Insulin and HOMA-IR did not change significantly [6]. In 8 trials in type 2 diabetes, fasting glucose fell 12.41 mg/dL and HbA1c 0.5 points [7]. The 108-trial review found fasting glucose 2.77 mg/dL lower [4].
Population
Adults with type 2 diabetes [5][7]. Adults in 27 RCTs [6] and 108 trials [4].
Sources
[4], [5], [6], [7]
Caveats
The reviews pooled different populations, and the fasting glucose drop in the type 2 diabetes review [7] is more than four times that in the all-adult reviews. The pooled standardized differences in [5] are very large (SMD -21.02 at 24 weeks), which points to small, varied trials. Heterogeneity in [7] was very high (I² 99.2% for fasting glucose), and its authors rate the included trials as low quality.
GinsengModerate

Blood sugar

Mixed results: one review found fasting glucose about 0.3 mmol/L lower, and a larger review found no significant effect on blood sugar.

Fasting insulin, HbA1c and HOMA-IR did not change overall.

The numbers and sources
Effect
Across 16 trials of 30 days or longer, ginseng lowered fasting blood glucose by 0.31 mmol/L (95% CI -0.59 to -0.03). Fasting insulin, HbA1c and HOMA-IR did not change overall [5]. A 2025 meta-analysis of 70 studies (4,506 participants) on cardiovascular risk factors found no significant effect on the glycemic profile, with a dose-response association for fasting glucose and fasting insulin [6].
Population
770 people with and without diabetes [5]. 4,506 participants in 70 studies [6].
Sources
[5], [6]
Caveats
The two reviews disagree on fasting glucose. Two thirds of trials in [5] ran under 12 weeks, and most participants already had well-controlled glucose [5].
NMNModerate

Insulin sensitivity and metabolic markers

Not shown to change weight, glucose, HbA1c or lipids across trials. One small trial found better insulin sensitivity in women with prediabetes.

HOMA-IR showed a downward trend that was not significant.

The numbers and sources
Effect
In women with prediabetes and overweight or obesity, insulin-stimulated glucose disposal measured by clamp rose after 10 weeks of NMN and did not change on placebo [7]. Across 15 trials, NMN did not change body weight, BMI, fasting glucose, HbA1c or lipids. HOMA-IR showed a downward trend that was not significant [8]. In the 60-day dose trial, HOMA-IR did not differ from placebo [1].
Population
Postmenopausal women with prediabetes [7]; 15 RCTs at 250 to 2,000 mg a day for 14 days to 24 weeks [8]; 80 middle-aged adults [1].
Sources
[7], [8], [1]
Caveats
The clamp result comes from a single small trial in one population [7]. The pooled trials were short [8].
NutsModerate

Blood sugar in type 2 diabetes

Shown to lower HbA1c by 0.07 percentage points and fasting glucose slightly in people with type 2 diabetes, in one meta-analysis of short trials.

Compared with diets with the same calories without tree nuts [12]

Fasting insulin and HOMA-IR did not change significantly.

The numbers and sources
Effect
A median 56 g a day of tree nuts lowered HbA1c (MD -0.07%, 95% CI -0.10 to -0.03) and fasting glucose (MD -0.15 mmol/L, 95% CI -0.27 to -0.02). Fasting insulin and HOMA-IR did not change significantly [12].
Population
450 people with diabetes in 12 randomized trials of 3 weeks or more [12].
Sources
[12]
Caveats
The reviewers describe most trials as short and of poor quality [12].
ResveratrolModerate

Blood sugar and insulin sensitivity

Mixed results: one review found lower glucose and insulin resistance in people with diabetes, while a later review found no effect. No effect without diabetes.

The numbers and sources
Effect
Across 11 RCTs, resveratrol reduced fasting glucose, insulin, HbA1c and HOMA insulin resistance in participants with diabetes. No significant effect on any glycemic measure was found in participants without diabetes [1]. A 2026 umbrella review pooling 10 meta-analyses in type 2 diabetes found no significant effect on fasting glucose, HbA1c, insulin or HOMA insulin resistance [2].
Population
388 participants in 11 RCTs [1]. Meta-analyses of trials in type 2 diabetes [2].
Sources
[1], [2]
Caveats
The two sources disagree on people with diabetes [1][2]. The pooled effects in people without diabetes did not vary by BMI, dose, duration or trial quality [1]. Heterogeneity was significant in [2].
Black seed oilLimitedStudied in women

Inflammation markers

One small trial found 1,000 mg a day lowered IL-6 in 60 women with PCOS. Trials of other inflammation markers conflicted.

Fasting insulin and HOMA-IR did not differ.

The numbers and sources
Effect
In 60 women with polycystic ovary syndrome, 1,000 mg a day of oil for 12 weeks lowered serum IL-6 against placebo (adjusted mean difference -4.21, 95% CI -6.34 to -2.08) and fasting glucose by 8.16 mg/dL. Fasting insulin and HOMA-IR did not differ [9]. A review of 4 human trials found conflicting results for the adhesion molecules VCAM-1 and ICAM-1 [10].
Population
60 women with PCOS [9]. Patients with coronary artery disease, type 2 diabetes, Hashimoto's thyroiditis or cardiovascular risk factors [10].
Sources
[9], [10]
Caveats
One small trial for IL-6 [9]. The adhesion molecule review also included 15 animal and in vitro studies, which are not counted here [10].

Type in your own result

How it compares with the reference method

Mixed results1

Moderate

HOMA-IR against the insulin clamp

Mixed results: HOMA-IR correlated with the insulin clamp at about 0.60 across 22 studies, and a rule built on it had 85% sensitivity and 79% specificity.

The numbers and sources
Compared with
Hyperinsulinemic euglycemic clamp
Effect
In the study that introduced it, the HOMA estimate of insulin resistance correlated with the clamp at 0.88 and had a coefficient of variation of 31%, which its authors said limits its use [16]. In a meta-analysis, log HOMA-IR correlated with the clamp at -0.60 (95% CI -0.66 to -0.53) across 22 studies [17]. In 2,321 people studied with the clamp, a decision rule built on HOMA-IR and body mass index identified insulin resistance with a sensitivity of 84.9% and a specificity of 78.7% [6].
Population
22 studies reporting correlations with the clamp [17]. 2,321 people, 2,138 of them without diabetes, at 17 European sites, San Antonio and the Pima Indian reservation [6].
Sources
[16], [17], [6]
Caveats
The clamp is a research procedure, and the sources state no single threshold for agreement. A US diabetes workgroup states that measures of insulin sensitivity are comparable only within individual studies [3].

Did not match the reference method2

Limited

Effect of the insulin assay and the blood sample

One study found HOMA estimates of insulin resistance for the same people ranged twofold, from 0.8 to 2.0, across 11 insulin assays.

The numbers and sources
Compared with
The same samples measured with 11 different insulin assays
Effect
Run on the same serum samples with 11 insulin assays, median HOMA estimates of insulin resistance ranged from 0.8 to 2.0 in people with normal glucose, from 1.9 to 3.2 in people with prediabetes and from 1.5 to 2.9 in people with type 2 diabetes. Insulin read 15% lower in heparinized plasma than in serum [18]. A 2023 laboratory guideline states that there is no standardized method to measure serum insulin and that attempts to harmonize assays gave greatly discordant results [2].
Population
12 people with normal glucose, 18 with prediabetes and 67 with type 2 diabetes [18].
Sources
[18], [2]
Caveats
A 2008 study, so individual assays may since have changed. It used a computer version of the model, not the formula. A laboratory report does not always name the insulin assay, which limits comparison of a result with a cut point set on a different one.
Limited

Variation from one test to the next

One study of 90 adults without diabetes found HOMA-IR varied 26.7% within a person across 10 weekly tests, driven largely by variation in insulin.

The numbers and sources
Compared with
The same person's fasting results on 10 weekly draws
Effect
The within-person variation of HOMA-IR was 26.7% (95% CI 25.5 to 28.3), which the authors attribute largely to variability in plasma insulin. No differences were seen between men and women or between people below and above 50. The authors conclude that HOMA-IR is highly variable in the same individual, which limits the value of single measurements [19].
Population
90 adults without diabetes (52 women) from five European countries, sampled weekly on 10 occasions [19].
Sources
[19]
Caveats
One study, in people without diabetes [19].

What studies tie it to

Linked in research4

Strong

Heart disease and other cardiovascular events

Linked to more coronary heart disease in adults without diabetes, 64% more in the highest than the lowest HOMA-IR group across pooled cohorts.

The numbers and sources
Effect
In a meta-analysis of adults without diabetes, the relative risk of coronary heart disease for high against low values was 1.64 (95% CI 1.35 to 2.00) for HOMA-IR, 1.52 (1.31 to 1.76) for fasting glucose and 1.12 (0.92 to 1.37) for fasting insulin. Per standard deviation higher it was 1.46 (1.26 to 1.69) for HOMA-IR, 1.21 (1.13 to 1.30) for glucose and 1.04 (0.96 to 1.12) for insulin [11]. A later meta-analysis of cohorts of healthy adults and adults with metabolic syndrome components found that a higher HOMA-IR went with more non-fatal major cardiovascular events (HR 1.46, 95% CI 1.08 to 1.97) and found no association with fatal ones [12].
Population
516,325 participants in 65 studies of glucose, insulin or HOMA-IR [11]. 215,878 participants in 38 cohort studies [12].
Sources
[11], [12]
Caveats
Observational. Each study compared its own high and low groups, measured with its own insulin assay, so the pooled groups share no common cut point.
Moderate

Developing type 2 diabetes

Linked to more new type 2 diabetes at higher HOMA-IR, about 87% more in a meta-analysis of cohorts, a weaker link than for fasting glucose.

The numbers and sources
Effect
In a meta-analysis of cohort studies, a higher HOMA-IR went with a hazard ratio of 1.87 (95% CI 1.40 to 2.49) for developing type 2 diabetes [12]. In a Dutch cohort, the odds ratio for type 2 diabetes in the highest against the lowest fifth was 2.8 (95% CI 1.4 to 5.6) for HOMA-IR and 1.9 (0.9 to 3.6) for fasting insulin, against 9.0 (4.4 to 18.5) for fasting glucose and 3.8 (2.0 to 7.2) for HbA1c [13].
Population
215,878 participants in 38 cohort studies across all outcomes [12]. 1,349 people aged 50 to 75 without diabetes, followed a mean 6.4 years, 152 of whom developed diabetes [13].
Sources
[12], [13]
Caveats
Observational. HOMA-IR contains fasting glucose, which is itself used to diagnose diabetes. A laboratory guideline reports that measures of insulin resistance predicted diabetes or coronary disease only moderately, with no threshold effects [2].
Strong

High blood pressure

Linked to more new high blood pressure, 43% more in the highest than the lowest HOMA-IR group across pooled cohorts of the general population.

The numbers and sources
Effect
Comparing the highest with the lowest category, the pooled adjusted risk ratio for developing hypertension was 1.43 (95% CI 1.27 to 1.62) for HOMA-IR and 1.54 (1.34 to 1.76) for fasting insulin [14]. A second meta-analysis found a hazard ratio for hypertension of 1.35 (95% CI 1.15 to 1.59) with a higher HOMA-IR [12].
Population
55,059 participants with 10,230 cases of hypertension in 11 prospective studies [14]. 215,878 participants in 38 cohort studies across all outcomes [12].
Sources
[14], [12]
Caveats
Observational, so confounding by body weight and other factors cannot be ruled out. Each study defined its own highest and lowest groups.
ModerateStudied in women

Polycystic ovary syndrome

Linked to higher HOMA-IR in women with polycystic ovary syndrome, 2.68 in non-obese and 4.38 in obese women with it, against 1.34 and 2.44 without it.

The numbers and sources
Effect
Pooled mean HOMA-IR was 4.38 (95% CI 3.84 to 4.92) in obese women with PCOS, 2.68 (2.16 to 3.20) in non-obese women with PCOS, 2.44 (2.06 to 2.82) in obese women without PCOS and 1.34 (1.06 to 1.63) in non-obese women without it. Every group differed from the others except non-obese women with PCOS and obese women without it [20]. In 28 insulin clamp studies, insulin sensitivity was 27% lower in women with PCOS than in controls (99% CI ±6%), independent of body mass index [21].
Population
3,037 women in observational studies, in four groups by PCOS and obesity [20]. 28 clamp studies of premenopausal women with PCOS and controls [21].
Sources
[20], [21]
Caveats
Observational. Non-obese women with PCOS and obese women without it had similar values, so body weight is tied to HOMA-IR about as strongly as the condition is [20]. The pooled means come from studies using different insulin assays (see Effect of the insulin assay and the blood sample).

Mixed results1

Moderate

Death from any cause

Mixed results: one meta-analysis tied the highest HOMA-IR group to 34% more deaths from any cause, while another found no link with fatal cardiovascular events or cancer deaths.

The numbers and sources
Effect
In adults without diabetes, the pooled adjusted risk ratio for death from any cause comparing the highest with the lowest category was 1.34 (95% CI 1.11 to 1.62) for HOMA-IR and 1.13 (1.00 to 1.27, P = 0.058) for fasting insulin. For cardiovascular death it was 2.11 (1.01 to 4.41) for HOMA-IR in two studies [15]. A later meta-analysis found no association of a higher HOMA-IR with fatal major cardiovascular events or with cancer mortality [12].
Population
26,976 adults without diabetes in 7 articles [15]. 215,878 participants in 38 cohort studies across all outcomes [12].
Sources
[15], [12]
Caveats
Observational. The authors of the first analysis call the findings for cardiovascular death unreliable because so few studies were included [15].

Sources

  1. US Food and Drug Administration. 21 CFR 862.1405, Immunoreactive insulin test system. Electronic Code of Federal Regulations. https://www.ecfr.gov/current/title-21/section-862.1405
  2. Sacks DB, Arnold M, Bakris GL, et al. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care. 2023. https://doi.org/10.2337/dci23-0036
  3. Staten MA, Stern MP, Miller WG, Steffes MW, Campbell SE; Insulin Standardization Workgroup. Insulin Assay Standardization: Leading to measures of insulin sensitivity and secretion for practical clinical care. Diabetes Care. 2010. https://doi.org/10.2337/dc09-1206
  4. Moriyama K. Mini-review on insulin resistance assessment: Advances in surrogate indices and clinical applications. World Journal of Clinical Cases. 2025. https://doi.org/10.12998/wjcc.v13.i29.108380
  5. Bonora E, Kiechl S, Willeit J, et al. Prevalence of insulin resistance in metabolic disorders: the Bruneck Study. Diabetes. 1998. https://doi.org/10.2337/diabetes.47.10.1643
  6. Stern SE, Williams K, Ferrannini E, et al. Identification of Individuals With Insulin Resistance Using Routine Clinical Measurements. Diabetes. 2005. https://doi.org/10.2337/diabetes.54.2.333
  7. Gayoso-Diz P, Otero-González A, Rodriguez-Alvarez MX, et al. Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study. BMC Endocrine Disorders. 2013. https://doi.org/10.1186/1472-6823-13-47
  8. Wu C, Ke Y, Nianogo RA. Trends in Hyperinsulinemia and Insulin Resistance Among Nondiabetic US Adults, NHANES, 1999-2018. Journal of Clinical Medicine. 2025. https://doi.org/10.3390/jcm14093215
  9. Tohidi M, Ghasemi A, Hadaegh F, et al. Age- and sex-specific reference values for fasting serum insulin levels and insulin resistance/sensitivity indices in healthy Iranian adults: Tehran Lipid and Glucose Study. Clinical Biochemistry. 2014. https://doi.org/10.1016/j.clinbiochem.2014.02.007
  10. Schrank Y, Fontes R, Perozo AFDF, et al. Proposal for fasting insulin and HOMA-IR reference intervals based on an extensive Brazilian laboratory database. Archives of Endocrinology and Metabolism. 2024. https://doi.org/10.20945/2359-4292-2023-0483
  11. Gast KB, Tjeerdema N, Stijnen T, Smit JW, Dekkers OM. Insulin Resistance and Risk of Incident Cardiovascular Events in Adults without Diabetes: Meta-Analysis. PLoS ONE. 2012. https://doi.org/10.1371/journal.pone.0052036
  12. González-González JG, Violante-Cumpa JR, Zambrano-Lucio M, et al. HOMA-IR as a predictor of Health Outcomes in Patients with Metabolic Risk Factors: A Systematic Review and Meta-analysis. High Blood Pressure and Cardiovascular Prevention. 2022. https://doi.org/10.1007/s40292-022-00542-5
  13. Ruijgrok C, Dekker JM, Beulens JW, et al. Size and shape of the associations of glucose, HbA1c, insulin and HOMA-IR with incident type 2 diabetes: the Hoorn Study. Diabetologia. 2018. https://doi.org/10.1007/s00125-017-4452-7
  14. Wang F, Han L, Hu D. Fasting insulin, insulin resistance and risk of hypertension in the general population: A meta-analysis. Clinica Chimica Acta. 2017. https://doi.org/10.1016/j.cca.2016.11.009
  15. Zhang X, Li J, Zheng S, et al. Fasting insulin, insulin resistance, and risk of cardiovascular or all-cause mortality in non-diabetic adults: a meta-analysis. Bioscience Reports. 2017. https://doi.org/10.1042/BSR20170947
  16. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985. https://doi.org/10.1007/BF00280883
  17. Otten J, Ahrén B, Olsson T. Surrogate measures of insulin sensitivity vs the hyperinsulinaemic-euglycaemic clamp: a meta-analysis. Diabetologia. 2014. https://doi.org/10.1007/s00125-014-3285-x
  18. Manley SE, Luzio SD, Stratton IM, Wallace TM, Clark PM. Preanalytical, Analytical, and Computational Factors Affect Homeostasis Model Assessment Estimates. Diabetes Care. 2008. https://doi.org/10.2337/dc08-0097
  19. Carobene A, Kilpatrick E, Bartlett WA, et al. The biological variation of insulin resistance markers: data from the European Biological Variation Study (EuBIVAS). Clinical Chemistry and Laboratory Medicine. 2025. https://doi.org/10.1515/cclm-2024-0672
  20. Behboudi-Gandevani S, Ramezani Tehrani F, Rostami Dovom M, et al. Insulin resistance in obesity and polycystic ovary syndrome: systematic review and meta-analysis of observational studies. Gynecological Endocrinology. 2016. https://doi.org/10.3109/09513590.2015.1117069
  21. Cassar S, Misso ML, Hopkins WG, et al. Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies. Human Reproduction. 2016. https://doi.org/10.1093/humrep/dew243

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