Higher Insulin Resistance Predicts Incident T2D, CKD

Marlene Busko, for Medscape

February 22, 2023

The study covered in this summary was published on Research Square as a preprint and has not yet been peer reviewed.

Key Takeaways

Why This Matters

  • Better prevention of incident diabetes in its early, reversible phase depends on identifying people who are at high risk of diabetes and its complications.

  • Findings from prior studies left unclear whether insulin resistance is a complication and consequence of diabetes or a risk factor for development of diabetes.

  • The findings suggest that assessment of IR based on a person's HOMA-IR level could identify healthy, middle-aged people at risk for developing type 2 diabetes.

Study Design

  • Researchers analyzed prospectively collected data during a median 9.9 years' follow-up from 4314 adults living in either of two cities in South Korea who were 40–65 years old and free of diabetes when enrolled in the Korean Health and Genome Study during June 2001 to January 2003.

  • Researchers subdivided the participants into three tertiles by their baseline HOMA-IR levels: 1822 were in the low subgroup, 1248 were classified with moderate levels, and 1244 had a high level.

Key Results

  • The mean age of the participants was 51, and about half were men.

  • The mean values of HOMA-IR were 1.09 in the lowest tertile, 1.61 in the moderate tertile, and 2.53 in the high tertile.

  • During follow-up, 168 participants received a diagnosis of incident type 2 diabetes, and 425 participants developed incident CKD.

  • The rates of incident type 2 diabetes and incident CKD were 6.8% and 12.2%, respectively, among people in the highest HOMA-IR tertile, significantly more than in the low and moderate tertiles for both outcomes, but the rate of new macrovascular disease was similar in the three HOMA-IR tertiles, with rates that ranged from 1.7% to 2.7%.

  • In an analysis that adjusted for 15 potential confounders, people in the tertile with the highest HOMA-IR had a significant 2.07-fold increased rate of type 2 diabetes and a significant 42% relative increase in the rate of incident CKD compared with people in the lowest HOMA-IR tertile. People in the moderate tertile had rates that were not significantly different from the lowest tertile.


  • The authors assessed IR with HOMA-IR and not with the established standard assessment that uses a hyperinsulinemia-euglycemic glucose clamp.

  • The authors obtained clinical data with standardized questionnaires administered by trained interviewers.

  • The study lacked data about certain types of microvascular events such as retinopathy and lacked medication data.


  • The study did not receive commercial funding.

  • None of the authors had disclosures.

This is a summary of a preprint research study, "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," written by researchers from three institutions in South Korea, published on Research Square, and provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on researchsquare.com.

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