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Printed on 7/19/2026
For informational purposes only. This is not medical advice.
HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) uses fasting glucose and fasting insulin to estimate insulin resistance. Higher values suggest lower insulin sensitivity and are often used in metabolic risk evaluation.
Formula: HOMA-IR = (Fasting Insulin [uIU/mL] x Fasting Glucose [mg/dL]) / 405.
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HOMA-IR requires a true fasting blood draw (8–12 hours of fasting, no food or caloric beverages). Both fasting glucose and fasting insulin must be measured from the same morning fasting sample. Glucose is measured in mg/dL and insulin in µIU/mL (microinternational units per milliliter).
Input your fasting glucose (mg/dL) and fasting insulin (µIU/mL). The calculator uses the HOMA-IR formula adapted for mg/dL units: HOMA-IR = (fasting insulin × fasting glucose) / 405. The divisor 405 converts glucose from mg/dL to mmol/L equivalents used in the original Matthews et al. formula.
Results below 1.0 are optimal insulin sensitivity. The range 1.0–2.9 represents normal to mildly elevated, with values above 2.0 raising concern for early insulin resistance in many Western populations. A HOMA-IR above 2.9 suggests significant insulin resistance. Cutoffs are population-specific; South Asian individuals may have clinically significant insulin resistance at lower values.
Internists, endocrinologists, cardiologists
Quantify insulin resistance as part of metabolic syndrome assessment (alongside abdominal obesity, hypertriglyceridemia, low HDL, and elevated blood pressure). HOMA-IR provides a more direct measure of insulin resistance than any single metabolic criterion and strengthens the overall picture.
Gynecologists, reproductive endocrinologists
Estimate insulin resistance in polycystic ovary syndrome (PCOS), where 50–70% of women have insulin resistance independent of BMI. A HOMA-IR above 2.5 is often used as a threshold in PCOS. Guides decisions about metformin therapy and lifestyle interventions.
Primary care, preventive medicine
Identify patients with prediabetes who have insulin resistance as the primary driver. HOMA-IR can be elevated even when fasting glucose is still normal, making it an earlier indicator of metabolic dysfunction than glucose alone.
Hepatologists, gastroenterologists
Assess insulin resistance in non-alcoholic fatty liver disease (NAFLD) / metabolic dysfunction-associated steatotic liver disease (MASLD). HOMA-IR correlates with hepatic steatosis severity and is used in non-invasive staging scores. Elevated HOMA-IR is associated with progression to NASH.
Endocrinologists, dietitians, exercise physiologists
Track improvements in insulin sensitivity over time in response to weight loss, dietary changes, or exercise programs. A 5–7% reduction in body weight often reduces HOMA-IR by 20–40%, providing objective evidence of metabolic improvement even when glucose remains normal.
Even a small snack or coffee with milk can spike insulin levels significantly, dramatically elevating HOMA-IR and creating a falsely high result. Instruct patients to fast overnight and come for the blood draw before breakfast. Water is acceptable. A non-fasting sample renders the result uninterpretable.
Different laboratories use different insulin assay methods (RIA, ECLIA, CLIA) that are not standardized, leading to systematic differences in insulin values — sometimes by 20–30%. Absolute HOMA-IR cutoffs (e.g., 2.0) established in one study may not directly apply to another lab's assay. Serial measurements within the same lab are more meaningful than single values against published thresholds.
South Asian individuals often develop metabolic complications at lower BMI and lower HOMA-IR values than Western European populations. Some studies suggest HOMA-IR thresholds of 1.5–2.0 may be more appropriate for South Asian patients. Ethnic-specific reference ranges should be applied when available.
Women with PCOS frequently have HOMA-IR values in the 2.5–5.0 range even without obesity. Insulin resistance in PCOS contributes to hyperandrogenism, anovulation, and cardiovascular risk. Metformin improves insulin sensitivity and is often initiated when HOMA-IR is elevated in this context.
The Triglyceride-Glucose (TyG) index = ln[triglycerides (mg/dL) × fasting glucose (mg/dL) / 2] provides a complementary insulin resistance estimate that doesn't require fasting insulin. The non-HDL/HDL cholesterol ratio and triglyceride/HDL ratio also correlate with insulin resistance. Using multiple markers increases confidence in the assessment.
In overweight and obese patients, modest intentional weight loss has a disproportionately large effect on insulin resistance. A 5–7% body weight reduction — the minimum recommended by diabetes prevention programs — consistently reduces HOMA-IR by 20–40% in clinical trials. This is a powerful motivational statistic for patient counseling.
HOMA-IR is a research and clinical risk-stratification tool, not a diagnostic test for diabetes or prediabetes. Diabetes diagnosis requires HbA1c, fasting glucose, or oral glucose tolerance test (OGTT) by established criteria. A high HOMA-IR with normal glucose indicates pre-diabetic insulin resistance, not diabetes itself.
In early insulin resistance, the pancreas compensates by secreting more insulin to maintain normal fasting glucose. This results in a high HOMA-IR (high insulin × normal glucose) but a normal fasting glucose. HOMA-IR can detect this compensated state years before glucose rises above normal, making it a useful early screening tool.
Regular aerobic exercise and resistance training both reduce insulin resistance through mechanisms independent of weight change — including improved skeletal muscle glucose uptake and reduced hepatic glucose output. Patients who maintain weight but increase physical activity show meaningful HOMA-IR reductions, reinforcing exercise as a first-line intervention.
HOMA-IR was developed by Matthews et al. (Diabetologia 1985). The original formula uses mmol/L; the mg/dL adaptation divides by 405. Validation studies suggest HOMA-IR correlates well with gold-standard euglycemic hyperinsulinemic clamp (r=0.88). Reference ranges vary by population; most Western studies use >2.0-2.5 as a threshold for insulin resistance.
Higher HOMA-IR values generally reflect greater insulin resistance and lower metabolic insulin sensitivity.
Use this tool in metabolic risk assessment, prediabetes evaluation, and endocrine follow-up where fasting insulin is available.
HOMA-IR depends on fasting conditions and assay variability. Thresholds differ across populations and labs, so results should be interpreted within local reference context.
For related assessments, see HbA1c Converter, Insulin Correction and BMI Calculator.
Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.
April 21, 2026 · trust-baseline
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