Homeostasis model assessment of insulin resistance in non-diabetic heart failure patients: a case-control investigation at tertiary care Hospitals of Karachi

ABSTRACT

Heart failure is a progressive, chronic disorder. Insulin resistance [IR] has been more and more involved as a preliminary metabolic perturbance predisposing to hyperglycemia, hyperlipidemia and atherosclerosis with others heart diseases. To investigate the relation of insulin resistance [IR] in non-diabetic heart failure patients this case-control study was carried out to ascertain the presence of IR with the aid of Homeostasis Model Assessment of Insulin Resistance [HOMA-IR] in non-diabetic heart failure patients [NDHF patients] compared with healthy controls. The sample size was calculated for both, cases [NDHF patients] and control [healthy subjects], which was initially consisted of 113 respondents each. The study consisted of two phase duration. In Phase I, NDHF patients were approached initially; only 80 patients with NDHF completed the study procedure. In Phase II, 80 healthy subjects were targeted and matched. Fasting blood glucose level [FBGL] and serum insulin was estimated. Mathematical model to quantify beta-cell function and insulin resistance was also computed through Homeostasis Model Assessment of Insulin Resistance [HOMA-IR] in both groups. Data was analyzed on SPSS version 16. Mean values with +/- standard deviation [SD] of insulin [10.2+/-4.36] and HOMA-IR [2.52+/-1.15] were significantly [p <0.05] higher in NDHF patients as compared to control subject [6.4+/-3.39, 1.45+/-0.80]. Average insulin to glucose ratio was 0.10+/-0.044 in NDHF patients which was significantly [p <0.0001] lowered in controls i.e., 0.073+/-0.039. Marginal and matrix plot analysis revealed that a higher patients count have had the HOMA-IR values <1.5 units while opposite scenario was observed in control group. Regression analyses of HOMA-IR with FBGL [as independent indicator] also authenticate the similar pattern. The present study concludes that insulin resistance [decreased insulin sensitivity] is a characteristic finding in Pakistani population of heart failure as compared to matched healthy controls