Lab reference
HOMA-IR
What the research found.
One study set the HOMA-IR cut-off in a group of adults two different ways, and got two different answers. Take the top tenth of the group as abnormal and the cut-off is 3.46, while taking the parts of metabolic syndrome into account drops it to 2.05. That's one group of people and one paper, with a cut-off that nearly halves depending on how the question gets asked.
In that one group of adults, the best cut-off also differed by sex and by age, ranging from 1.58 to 2.47. The low end belonged to women who had diabetes, and the high end to women of seventy who didn't. Every one of those values fell between the 70th and 75th percentile of the group, which tells you they are all the outcome of where somebody chose to draw a line.
Gayoso-Diz and colleagues, BMC Endocrine Disorders, 2013
One study compared rheumatoid arthritis against lupus and found the rheumatoid arthritis patients more insulin resistant. Their insulin sensitivity came in 27 points lower than the lupus patients', with the true value falling somewhere from minus 46 to minus 9, and their pancreas output came in 38 points higher. Their odds of meeting the study's definition of insulin resistance were 2.15 times higher.
Quevedo-Abeledo and colleagues, Journal of Rheumatology, 2020
That study had to borrow its cut-offs, and it took them from a Spanish general population. They were 1.85 in men, and in women they ranged from 2.07 to 2.47 depending on age. Borrowing is a reasonable thing for researchers to do when nothing better exists, and it's also the reason no cut-off here can be called checked in rheumatic disease.
Quevedo-Abeledo and colleagues, Journal of Rheumatology, 2020
What the number means.
| Band | Value | What it means | Source |
|---|---|---|---|
| Top tenth taken as abnormal | 3.46 | The cut-off in one group of adults when the top tenth counts as abnormal. | Gayoso-Diz 2013 |
| Metabolic syndrome method | 2.05 | One group of adults, one paper, a different method, and the cut-off nearly halves. | Gayoso-Diz 2013 |
| Best value by sex and age | 1.58 to 2.47 | From women with diabetes to women of seventy without it. All fell between the 70th and 75th percentile. | Gayoso-Diz 2013 |
| What rheumatology research uses | 1.85 in men, 2.07 to 2.47 in women | Borrowed from a Spanish general population. Not worked out in rheumatic disease. | Quevedo-Abeledo 2020 |
| A cut-off checked in rheumatic disease | Not checked | Every number above comes from people without the disease. Not one was tested against a rheumatic outcome. | No source, because no target is set |
A reference range is not a target. Where a range on this page differs from the one your laboratory prints, the difference is explained above and sourced below. Where no trial has tested a target, this page says so rather than offering one.
What the calculation is
HOMA-IR is short for homeostatic model assessment of insulin resistance, and the first thing to know about it is that it's a sum rather than a measurement. You take a fasting glucose and a fasting insulin, multiply the two together, and then divide by a fixed number. The answer estimates how much insulin your body needs in order to hold your blood sugar level, which is what insulin resistance means.
The appeal is obvious once you know what the alternative involves. Measuring insulin resistance properly needs a drip study lasting hours, and hardly anybody outside a research lab will do that, while two fasting blood values and a formula are available anywhere. Across large groups the estimate tracks the hard methods well enough, which is why the measure exists and why it turns up in so many papers.
Why the cut-off moves
The trouble starts when a sum built for comparing groups gets used to sort one person. One study shows that problem better than any argument could, because somebody analyzed a large group of adults to find the HOMA-IR cut-off for insulin resistance and the answer depended entirely on how they framed the question. Every figure below comes from that one study, in that one group of people.
Take the top tenth as abnormal and the cut-off was 3.46. Take the parts of metabolic syndrome into account instead and it was 2.05. Break it down by sex and by age and it moved again, to 1.85 in men without diabetes by one method and 2.27 by another. In women without diabetes it was 2.07 at fifty and 2.47 at seventy, and in people who had diabetes it was 1.58 to 1.60. Every one of those values fell between the 70th and 75th percentile of the group.
That range spans more than a twofold difference in where the line falls. So picture somebody with a HOMA-IR of 2.5, who is insulin resistant by one method and not by another, in one group of people and one paper. A single cut-off quoted without saying which method produced it isn't a fact about your body.
What rheumatology research has settled
Insulin resistance in inflammatory disease is worth attention, and the research makes that case without needing a cut-off at all. One study measured insulin resistance in rheumatoid arthritis and in lupus, and the rheumatoid arthritis patients came out worse. Their insulin sensitivity was 27 points lower, with the true value falling somewhere from minus 46 to minus 9, and their pancreas output was 38 points higher, meaning the pancreas was working harder to hold blood sugar where it was.
They also met the study's definition more often, at an odds ratio of 2.15, which is odds rather than risk. Look at where that definition came from, though. The study took its cut-offs from a Spanish general population, at 1.85 in men and at 2.07, 2.36, or 2.47 in women of thirty, fifty, and seventy. That's a sensible research choice when nothing better exists, and it's also the reason no cut-off on this measure can be called checked in rheumatic disease.
One thing is missing from this whole body of research. No treatment has ever been aimed at HOMA-IR in a rheumatic patient, so even somebody who accepted a cut-off would be stuck without evidence about what to do when a patient crossed it. That's the practical end of the argument, whatever you make of the number itself.
Why insulin resistance still deserves attention
The idea holds up even where the number doesn't. Long-running inflammation gets in the way of how insulin signals, inflammatory arthritis cuts how much people move for obvious reasons, and steroids raise blood sugar directly. Each of those is a plausible road from rheumatic disease to worse metabolic health, and the measured difference between rheumatoid arthritis and lupus fits all three, though no study here says how much each one contributes.
Heart disease is a leading cause of death in inflammatory arthritis, and your blood sugar is one thing you can change that feeds into that risk. So the worry underneath all of this is well founded. What follows from it is a reason to look after your blood sugar and your weight, rather than a reason to aim at a particular HOMA-IR value.
What to measure instead
Say your worry is your heart and your blood sugar. Several measures have what HOMA-IR lacks, meaning agreed cut-offs, agreed treatment targets, and trials showing that acting on them helps people. A fasting glucose and a test called hemoglobin A1c are the direct ones, while your blood pressure, a cholesterol panel, and your waist cover the rest, and all of them are cheap and easy to repeat.
Has somebody already ordered a HOMA-IR for you? Then ask them one thing, which is what they would do differently depending on the answer. That question is fair and it's answerable, and where the answer is nothing, the result is information with no use, which is worth knowing before you start tracking a number over time.
Questions patients ask.
What HOMA-IR value is normal?
There isn't one answer, and the reason for that teaches you something rather than dodging the question. In one group of adults the cut-off moved from 3.46 to 2.05 when the only thing that changed was the statistical method used to set it. Values by sex and age in that group ranged from 1.58 to 2.47, and all of them fell between the 70th and 75th percentile, so what counts as abnormal is a decision about where to draw a line.
Has a threshold been validated for people with rheumatoid arthritis?
No, and that's the main point of this page. The best study in this area compared rheumatoid arthritis against lupus, and it had to borrow its cut-offs from a Spanish general population, because no value worked out in rheumatology exists. That's a fair thing for researchers to do, and it also means any cut-off applied to you came from people who don't have your disease.
Is insulin resistance a real problem in inflammatory arthritis?
The problem is real even where the number is shaky. One study compared the two diseases head to head, and the rheumatoid arthritis patients were measurably more insulin resistant, with insulin sensitivity 27 points lower and pancreas output 38 points higher, meaning the pancreas was working harder. Inflammation, moving less, and steroid treatment could each plausibly contribute, so the idea deserves attention even though the cut-off won't take the weight people put on it.
Should I be tracking my HOMA-IR over time?
No treatment in rheumatic disease has ever been aimed at this number, so there's no evidence about what a change in it should make anybody do. It gets worked out from a fasting glucose and a fasting insulin, and both of those bounce around between blood draws. Watching a number move without knowing what to do about it buys you worry instead of action, so ask whoever ordered it what they'd change based on the result.
What should I be measured on instead?
Two tests have what HOMA-IR lacks, which are a fasting glucose and a test called hemoglobin A1c. Both have agreed cut-offs, agreed treatment targets, and trials showing that acting on them helps people, and your blood pressure, your cholesterol panel, and your waist have all of that going for them too. If the worry underneath all this is your heart and your blood sugar, and in inflammatory arthritis it usually should be, then those are the measures with something to act on.
Why is HOMA-IR used in research if it's this imprecise?
Three reasons, which are that it's cheap, that it needs only two fasting values, and that across large groups it tracks the far harder research methods well enough. So it's genuinely useful for comparing one group against another, which is what the studies on this page did. Comparing groups and sorting one person are two different jobs, and a target range would need the second one, which this measure can't do.
References.
- Gayoso-Diz P; Otero-González A; Rodriguez-Alvarez M 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;13. 10.1186/1472-6823-13-47Cross-sectional random population sample of 2
- Quevedo-Abeledo J; Sánchez-Pérez H; Tejera-Segura B et al. Higher Prevalence and Degree of Insulin Resistance in Patients With Rheumatoid Arthritis Than in Patients With Systemic Lupus Erythematosus. The Journal of Rheumatology. 2020;48:339-347. 10.3899/jrheum.200435Cross-sectional study of 413 subjects
This page gathers the published research on this subject into one place. The studies behind it were published between 1989 and 2026, and every figure links to the paper it came from. Those studies were peer reviewed. This summary of them was not. Dr. Sarah Luebker is reviewing these pages one at a time and has not reached this one yet, so it carries no medical review date and nothing here is her opinion or her advice to you. Each page gets updated as she reaches it. It is here in the meantime because the science is worth having in one organized place that is easy to find and easy to read. Talk to your own clinician before acting on any of it.