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The Reference Intervals and Roles of GIR, HOMA and QUICKI Indexes to Judge Insulin Resistance/Insufficiency for Newly Diagnosed Diabetes Mellitus.

BACKGROUND
To establish the reference intervals of GIR, HOMA, and QUICKI index and to identify the clinical value of the three indexes for newly diagnosed diabetes mellitus.


METHODS
The results of fasting glucose and insulin were acquired for 123 healthy individuals using Roche cobas-8000 to establish reference intervals of GIR, HOMA, and QUICKI based on Clinical and Laboratory Standards Institute (CLSI) EP28-A3. Meanwhile, 36 newly diagnosed type 1 and type 2 diabetes mellitus (DM) patients were enrolled to judge the effect of insulin resistance/insufficiency using the three indexes based on clinical initial treat-ment procedures. All the data were acquired from Wangjing Hospital, China Academy of Traditional Chinese Medicine.


RESULTS
The reference intervals of GIR, HOMA, and QUICKI were 5.83 - 21.15, 0.87 - 4.22, and 0.309 - 0.392, respectively. Concerning to GIR, HOMA, and QUICKI, there were 57.7% (15/26), 80.8% (21/26), and 80.8% (21/26) outside of the reference limit among type 2 DM patients, respectively; The area under the curve (AUC) of the GIR > 10.937, HOMA < 5.436, and QUICKI > 0.299 were 0.937 (95% CI 0.681 - 1.000), 0.689 (95% CI 0.510 - 0.868), and 0.689 (95% CI 0.510 - 0.868) by ROC curves when insulin insufficiency was judged based on whether insulin was included in initial treatment procedures. There concordance rates were 77.8% (28/36), 50% (18/36), and 50% (18/36) using the three indexes, GIR, HOMA, and QUICKI, respectively.


CONCLUSIONS
We established reference intervals for GIR, HOMA, and QUICKI. HOMA and QUICKI were more reliable indexes to identify insulin resistance among type 2 DM patients, but GIR was a more reliable index to identify insulin relatively or absolutely insufficiency than HOMA and QUICKI among DM patients.