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April 22, 2022

Biomarkers of Blood Glucose Regulation: HOMA2-%B

Optimal Takeaways

Insulin resistance can lead to an initial increase and then a decline in beta-cell function and insulin production, ultimately progressing to diabetes. Evaluating beta-cell function using the HOMA2-%B calculation helps evaluate where an individual is on the spectrum of blood glucose regulation and insulin sensitivity. Addressing beta-cell dysfunction early on provides an opportunity to make nutrition and lifestyle changes that can help reverse the progression to type 2 diabetes. HOMA2-%B should be evaluated alongside HOMA-2%S, an indicator of peripheral tissue sensitivity to insulin, as well as HOMA2-IR, an indicator of insulin resistance.

Conventional Lab Range: 70-120%

Optimal Dx’s Optimal Range: 90-110%

Low HOMA2-%B reflects declining beta-cell function and possible progression to diabetes as cells are less able to produce and secrete insulin. Values will be low in metabolic syndrome (Endukuru 2020, prediabetes, and diabetes (Elsafty 2018, Ghasemi 2015).

High HOMA2-%B represents an increase in beta cell activity and insulin secretion. This occurs early in insulin resistance as more insulin is required to regulate blood glucose.


HOMA2-%B reflects beta-cell function and production of insulin. It can increase with persistent insulin resistance, along with increasing HOMA2-IR, as the pancreas tries to compensate by producing more insulin to maintain normal glucose levels. At this point, nutrition and lifestyle changes may reverse the trend towards diabetes.

However, as beta cells start to fail, HOMA2-%B will begin to decline and progression to diabetes may be imminent, especially as values drop to 72.5% in women and 74.6% in men (Ghasemi 2015).

Insulin resistance is an important risk factor for metabolic syndrome, type 2 diabetes, and cardiovascular disease. HOMA2-%B will be significantly lower in established metabolic syndrome as demonstrated in a study of 75 metabolic syndrome patients and 75 controls. Those with metabolic syndrome fell within a HOMA2-%B range of 61-87%, while controls revealed a range of 97-129%. Researchers suggest a cut-off of 87.2 or below for metabolic syndrome (Endukuru 2020).

Evaluation of 400 adults with similar demographics noted a HOMA2-%B cut-off of 54.2% or above in healthy individuals; 54.2-34.4% in borderline diabetics, and below 34.4% in type 2 diabetics (Elsafty 2018).

It is important to evaluate HOMA2-%B alongside insulin sensitivity using HOMA2-%S in order to get a clearer picture of glucose tolerance and diabetes risk (Caumo 2006). HOMA2 calculations aren’t directly applicable to changes caused by medications such as sulfonylureas that stimulate beta-cell insulin secretion (Hill 2013).

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Caumo, Andrea et al. “New insights on the simultaneous assessment of insulin sensitivity and beta-cell function with the HOMA2 method.” Diabetes care vol. 29,12 (2006): 2733-4. doi:10.2337/dc06-0070

Elsafty, Ahmed, et al. "Specific Cutoffs for HOMA1-IR, HOMA2-IR, HOMA1-% B, and HOMA2-% B in Adult Egyptian Patients." American Journal of Clinical Pathology 150.suppl_1 (2018): S66-S66.

Endukuru, Chiranjeevi Kumar et al. “Cut-off Values and Clinical Utility of Surrogate Markers for Insulin Resistance and Beta-Cell Function to Identify Metabolic Syndrome and Its Components among Southern Indian Adults.” Journal of obesity & metabolic syndrome vol. 29,4 (2020): 281-291. doi:10.7570/jomes20071

Ghasemi, Asghar et al. “Cut-off points of homeostasis model assessment of insulin resistance, beta-cell function, and fasting serum insulin to identify future type 2 diabetes: Tehran Lipid and Glucose Study.” Acta diabetologica vol. 52,5 (2015): 905-15. doi:10.1007/s00592-015-0730-3

Hill, Nathan R et al. “Expansion of the homeostasis model assessment of β-cell function and insulin resistance to enable clinical trial outcome modeling through the interactive adjustment of physiology and treatment effects: iHOMA2.” Diabetes care vol. 36,8 (2013): 2324-30. doi:10.2337/dc12-0607

Tag(s): Biomarkers

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