HOMA-IR
A calculated score that estimates how well your body responds to insulin, using a fasting glucose and a fasting insulin from the same blood draw.
AI-verified against cited sources. Awaiting expert reviewAlso called HOMA-IR
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The usual range for HOMA-IR depends on age. Add your age above to see where you stand.
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What it is
HOMA-IR stands for homeostatic model assessment of insulin resistance. It is not measured directly. A lab or calculator multiplies your fasting glucose by your fasting insulin and divides by a constant. The idea is that when cells respond poorly to insulin, the body needs more insulin to keep glucose steady, so the score goes up. Higher scores point to more insulin resistance, and lower scores to better insulin sensitivity. The simple formula is called HOMA1. A computer model, HOMA2, gives somewhat different numbers.
Why it matters
Insulin resistance is a major risk factor for type 2 diabetes, and it is linked to high blood pressure and unhealthy blood fats. Because the body can keep glucose steady by making more insulin, HOMA-IR can sometimes change when a fasting glucose still looks fine. But it is mostly a research tool. No agreed cutoff exists, the score depends on the insulin assay, and the model's own authors noted low precision, with a coefficient of variation of about 31% for the insulin resistance estimate. Trends and the full picture matter more than one number.
If it’s low
A low HOMA-IR usually reflects good insulin sensitivity and is not a concern by itself. It is common in lean, active people. If glucose is high while insulin is low, the pancreas may not be making enough insulin, and a clinician would look at insulin production (HOMA-B, C-peptide) rather than this score.
Common causes
- Good insulin sensitivity, for example in lean or very active people
- Low insulin production, as in type 1 diabetes or later-stage type 2 diabetes
- An insulin assay that reads low for that sample
- A glucose sample that sat before the blood cells were separated
What can help
- Usually nothing is needed if your glucose and A1c are in range
- If glucose is high with a low score, ask your clinician whether insulin production should be checked
If it’s high
A higher HOMA-IR means your body needed more insulin to keep glucose steady on the morning of the test. That fits insulin resistance, which is common with extra body weight, low physical activity, prediabetes and diabetes. There is no single cutoff that works for everyone. Published cutoffs range from about 1.5 to about 3.8 across studies in different countries, depending on how they were set. Your clinician can look at it together with your glucose, A1c, blood pressure and blood fats.
Common causes
- Not fasting before the draw
- Extra body weight, especially around the waist
- Low physical activity
- Prediabetes or type 2 diabetes
- Polycystic ovary syndrome (PCOS)
- Fatty liver disease
- Some medicines, such as corticosteroids
What can help
- Regular physical activity, a balanced eating pattern and a healthy weight are the main lifestyle levers clinicians discuss for insulin resistance
- Ask whether to repeat the test fasting, at the same lab
- Ask whether other tests, such as A1c, blood fats or liver tests, would help
- Ask whether any of your medicines could be involved
If this applies to you
HOMA-IR means a little more for some people. Open the one that fits you.
Tracking for long-term health
HOMA-IR is worked out from fasting insulin and glucose, so it carries the same lab-to-lab problem. In 2010, an ADA workgroup said insulin sensitivity measures were used only in research, had no clinical applications yet, and gave results that were not comparable from one study to the next.
PCOS
Insulin resistance is a key part of PCOS, but the 2023 guideline says the measures available today, including insulin tests, are inaccurate and not recommended in routine care. It prefers an OGTT for checking blood sugar.
How common is your level?
NHANES describes the US civilian, non-institutionalized population, not a 'healthy' reference group. People with disease, on medication, fasting or not (except fasting-subsample markers), smokers and so on are all included. A percentile says where a value sits among Americans of that sex and age, not whether it is normal.
Use the left and right arrow keys to read each age. Shift moves five years.
Reference data derived from CDC/NCHS National Health and Nutrition Examination Survey (NHANES), cycles 2015-2016, 2017-March 2020 (pre-pandemic), August 2021-August 2023. Analysis by bloodtesttracker.com; not endorsed by CDC, NCHS or HHS.
Explore HOMA-IR by age and sex: every percentile as a table, with a download.
What can affect your result
- Fasting for at least 8 hours before the draw
- The insulin assay used, since assays are not standardized
- Body weight and fat around the waist, and physical activity
- Age and sex: one large study found the best cutoff changed with age in women
- Ethnicity and country: published cutoffs differ between populations
- Medicines, including corticosteroids and any injected insulin
- Pregnancy and illness
- Not fasting raises both glucose and insulin, which pushes the score up.
- Injected insulin is measured along with your own, so the score does not describe your own insulin resistance.
- Insulin assays are not standardized across labs, so the same sample can give different insulin values and a different score.
- High-dose biotin (vitamin B7) can interfere with some insulin immunoassays. Check with your clinician before stopping any supplement.
- A glucose sample that sits before the blood cells are separated can read falsely low, which lowers the score.
- Illness, stress and some medicines (for example corticosteroids) change glucose and insulin.
Morning, after an overnight fast of at least 8 hours. Glucose and insulin must come from the same blood draw. Reflects a single fasting sample. It can shift as weight, activity or medicines change.
When to talk to a clinician
A HOMA-IR result alone isn't an emergency. Talk with a clinician if the fasting glucose used in the calculation is 126 mg/dL (7.0 mmol/L) or higher and no one has gone over it with you, or if you have extreme thirst, frequent urination or unexplained weight loss.
Questions you could ask
- Which cutoff, if any, does my lab use, and was it set for people like me?
- Would tracking this over time help?
- Should we repeat this fasting, and at the same lab?
- How do my A1c, blood fats and liver tests fit with this score?
- Could any of my medicines affect my glucose or insulin?
- Does my glucose also need a closer look, or is this just good insulin sensitivity?
Questions people ask
What is a normal HOMA-IR?
There is no agreed normal range. Published cutoffs for insulin resistance range from about 1.5 to 3.8 depending on the country, the insulin assay and how the cutoff was set. Lower scores mean better insulin sensitivity. Use any cutoff on your report as one lab's or clinic's choice, and ask your clinician what it means for you.
How is HOMA-IR calculated?
Multiply fasting glucose in mg/dL by fasting insulin in µIU/mL, then divide by 405. With glucose in mmol/L, divide by 22.5 instead. For example, a glucose of 90 mg/dL (5.0 mmol/L) and an insulin of 8 µIU/mL gives 90 × 8 / 405, about 1.8.
Why does my HOMA-IR differ between labs?
Insulin assays are not standardized, so the same blood can give a different insulin value at different labs, and the score changes with it. Some labs also use the HOMA2 computer model rather than the simple formula. Compare results from the same lab when you can.
Show the science and sources
Is a change real?
HOMA-IR naturally varies about 26.7% from test to test in the same healthy person. Between two results from the same lab, a rise of 126% or more, or a fall of 56% or more, is unlikely to be day-to-day noise or lab variation (95% reference change value). Source: The biological variation of insulin resistance markers: data from the European Biological Variation Study (EuBIVAS) (Carobene A et al.).
For clinicians and researchers
HOMA1 (Matthews 1985) estimates insulin resistance from fasting values as glucose (mmol/L) × insulin (µIU/mL) / 22.5, or glucose (mg/dL) × insulin (µIU/mL) / 405. The model was checked against the euglycaemic clamp (Rs 0.88), but the authors reported low precision (CV 31% for the insulin resistance estimate). Levy 1998 (HOMA2) is titled as arguing that correct HOMA evaluation uses the computer program rather than the simple formula, and the two give somewhat different values. Insulin in µIU/mL equals mIU/L; conversion to pmol/L uses lab-specific factors (NHANES and ARUP use 6.0 per µIU/mL), and insulin assays are not standardized, so thresholds do not transfer cleanly between assays (Staten 2010). The score is not valid in people who inject insulin. There are no guideline cutoffs: ADA diagnostic criteria use glucose and A1c, not insulin, and a clinical review notes that indices like HOMA-IR have limited clinical use because reference values for normal and impaired insulin sensitivity are absent (Gutch 2015). Published cutoffs vary by race, age, sex and disease (Tang 2015). In the Spanish EPIRCE sample of 2,459 adults, the 90th percentile of HOMA-IR was 3.46, but the best cutoff for identifying people with metabolic syndrome features was 2.05 overall and 1.85 in men without diabetes, around the 70th to 75th percentile (Gayoso-Diz 2013). That paper tabulates studies elsewhere with cutoffs (percentile- or ROC-based) from about 1.5 to 3.8, including a US NHANES adult sample at 2.73 (66th percentile), so a single threshold should not be applied across populations.
Sources
- Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man, Diabetologia (1985)
- Correct homeostasis model assessment (HOMA) evaluation uses the computer program, Diabetes Care (1998)
- Assessment of insulin sensitivity/resistance, Indian Journal of Endocrinology and Metabolism (2015)
- 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)
- Optimal cut-off values for the homeostasis model assessment of insulin resistance (HOMA-IR) and pre-diabetes screening: Developments in research and prospects for the future, Drug Discoveries & Therapeutics (2015)
- Insulin resistance markers HOMA-IR, TyG and TyG-BMI index in relation to heart failure risk: NHANES 2011-2016, PLOS ONE (2025)
- Insulin assay standardization: leading to measures of insulin sensitivity and secretion for practical clinical care, Diabetes Care (2010)
AI-verified against cited sources. Awaiting expert review. Last reviewed 2026-10-03. How we build and check these pages.