Diagnosis · Insulin Resistance

How IR is assessed

While the euglycemic clamp is the research gold standard, clinical practice relies on validated indices and biomarkers.

Clinical indices (fasting glucose & insulin)

Index	Formula	Cut‑off for IR
HOMA‑IR	(Glucose [mg/dL] × Insulin [µU/mL]) / 405	> 2.0 (commonly used)
QUICKI	1 / (log[Glucose] + log[Insulin])	< 0.339
Triglyceride/Glucose index	Ln (TG [mg/dL] × Glucose [mg/dL] / 2)	> 4.5 (variable)

Other laboratory and clinical markers

Metabolic: hyperuricemia, elevated homocysteine, increased fibrinogen.
Inflammatory: elevated CRP, microalbuminuria (endothelial dysfunction).
Clinical signs: acanthosis nigricans, hypertension, increased waist circumference (>88 cm for women, >102 cm for men).

Special considerations for women

In PCOS, HOMA‑IR or the triglyceride/glucose index is recommended.
Waist circumference is a powerful independent predictor, especially in perimenopausal women.

📊 Remission criteria (when IR is reversed): fasting glucose < 100 mg/dL, HOMA‑IR < 2.0, HbA1c < 5.7% (or < 6.5% if diabetes), and waist circumference reduction.

Based on ADA, WHO, and multiple cohort studies.