HOMA-IR and cardiovascular risk in type 2 diabetes mellitus: Current evidence and clinical perspectives
Year: 2026
Type: article
Abstract: Background: Type 2 Diabetes Mellitus (T2DM) is a major metabolic disorder associated with increased Cardiovascular Disease (CVD) risk. Insulin resistance is central to T2DM pathophysiology and contributes to endothelial dysfunction, dyslipidemia, hypertension, inflammation, oxidative stress, and atherosclerosis. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) is a widely used surrogate measure of insulin resistance based on fasting glucose and insulin concentrations. Objective: This review examines the physiological basis of insulin resistance, the principles and clinical utility of HOMA-IR, and the mechanisms linking insulin resistance with cardiovascular risk in T2DM. The potential role of HOMA-IR-associated biomarkers in cardiovascular risk assessment is also discussed. Methods: Relevant evidence from mechanistic studies, observational studies, clinical investigations, systematic reviews, and meta-analyses addressing HOMA-IR, insulin resistance, T2DM, CVD, and cardiometabolic biomarkers was reviewed. Results: Insulin resistance promotes metabolic and vascular abnormalities associated with cardiovascular risk, including endothelial dysfunction, oxidative stress, chronic inflammation, atherogenic dyslipidemia, hypertension, and vascular remodeling. HOMA-IR is a practical and inexpensive surrogate marker that has been associated with cardiometabolic risk factors and subclinical vascular disease. However, variability in insulin assays, populations, and cutoff values limits its universal clinical application. Emerging inflammatory, endothelial, metabolic, and molecular biomarkers may complement HOMA-IR. Conclusion: HOMA-IR is a useful marker of insulin resistance in T2DM but should be interpreted alongside conventional cardiovascular risk factors and validated risk-assessment tools. Further prospective studies are needed to establish its role in cardiovascular risk prediction.
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7213627238