August 2nd, 2021

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A Novel Index to Overcome the Assessment Limitations of Insulin Resistance in Polycystic Ovary Syndrome: Homeostatic Model Assessment Index to Red Blood Cell Distribution Width Ratio
Authors:  Tugba Gurbuz, M.D., and Oya Gokmen, M.D.
  OBJECTIVE: To investigate the effectiveness of insulin, the homeostatic model assessment (HOMA) index, and red blood cell distribution width (RDW) parameters together in the diagnosis of polycystic ovary syndrome (PCOS).

STUDY DESIGN: This long-term study was designed as a single-center cohort analysis. The study included 100 women with PCOS and 100 healthy women. To determine insulin resistance (IR), fasting glucose and insulin of each patient were measured and HOMA was calculated. Red blood cell distribution width was measured and combined with insulin and HOMA.

RESULTS: Insulin, HOMA-IR, and RDW increased in PCOS (p<0.0001). The cutoff point for insulin was >9.21, while HOMA-IR was >1.98. Both “insulin to RDW” and “HOMA to RDW” ratios showed a significant increase in PCOS (p<0.0001). The cutoff of “insulin to RDW” was >0.255, which correlated with PCOS (AUC: 83.8%, p<0.0001; standard error: 0.027). The diagnostics, including sensitivity, specificity, and positive and negative predictive values, were 77%, 75.1%, 73.2%, and 77.1%, respectively. The cutoff of “HOMA to RDW” was >0.052, which correlated with the PCOS (AUC: 85.4%, p<0.0001). The diagnostics of “HOMA to RDW” were 81%, 71.3%, 74.1%, and 75.2%, respectively.

CONCLUSION: HOMA used in the assessment of IR in PCOS becomes a stronger diagnostic tool when evaluated together with RDW. Their combination might provide diagnostic information without adding any extra cost.
Keywords:  diabetes, diagnostic tests, HOMA, homeostatic model assessment index, insulin resistance, PCOS, polycystic ovary syndrome, RDW, red blood cell distribution width
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