Is Homeostasis Model Assessment Better Than the Quantitative Insulin-Sensitivity Check Index and Fasting Glucose/Insulin Ratio?: In Reply

In Reply.—Insulin resistance is a state in which normal concentrations of insulin produce a subnormal biological response. It is difficult to distinguish between relative effects of insulin resistance and hyperinsulinemia. The degree of hyperinsulinemia and the presence of accompanying insulin resistance may form the basis for some of these conflicting effects.A variety of methods have been developed to detect the presence of insulin resistance. There is no universally accepted and clinically useful method to measure insulin resistance. The euglycemic insulin clamp technique is the gold standard. This test, however, does not reproduce physiologic conditions. The oral glucose-tolerance test remains the method of practical choice for detecting impaired glucose tolerance in children. Hyperinsulinemia represents the pathophysiologic step between insulin resistance and impaired glucose tolerance.In previous studies, the sum of insulin levels during the oral glucose-tolerance test has been used to subdivide obese patients as normoinsulinemic or hyperinsulinemic. These studies showed that hyperinsulinemia itself is associated with increased risk for components of the metabolic syndrome. Although additional studies are needed, it might seem logical to consider this index as an insulin-resistance index.