Estimating insulin sensitivity and beta cell function: perspectives from the modern pandemics of obesity and type 2 diabetes

The 1985 manuscript describing the HOMA model, by Matthews and colleagues, is the most cited paper in the history of Diabetologia. In this edition of ‘Then and now’ we assess the impact of this seminal paper by considering the contribution of this elegant work in the context of the most rapidly changing period in the history of diabetes. HOMA was born in the middle of an ‘era’ of insulin resistance, and was subsequently nurtured and grew during the ‘eras’ of insulin sensitisers and diabetes prevention. From the modern era of insulin resistance onward, researchers have sought a convenient method for measuring insulin sensitivity and secretion, and found this in HOMA. However, the explosion in the prevalence of diabetes clearly underlines that an understanding of insulin resistance and how it can be measured has been insufficient to make any impact on the growing pandemic of diabetes. Knowledge of individual physiology is important, but the dramatic impact of the modern environment may be the factor that has escaped attention until very recently. An optimist can only state that the coming ‘era’ in diabetes research will be a period of true translation of scientific insight and implementation of effective disease prevention.