The IR Issue: Evidence-Based Testing

A recent analysis of NHANES data from 2021 found that 40% of US adults aged 18 to 44 are insulin-resistant (IR) based on HOMA-IR measurements. While obesity rates have increased considerably over the past 2 decades, this rapid increase in prevalence was not only associated with increased adiposity. Hypertension, dyslipidemia, and limited physical activity also increased insulin resistance. PCOS and IR are intimately tied, although not all PCOS patients will have clinical or biochemical evidence of IR. And remember this clinical pearl: IR is NOT included in the diagnostic criteria for PCOS. According to published estimates, insulin resistance may be found in 44% to 90% of people with PCOS (the widespread percentage is due to various testing modalities and PCOS phenotypes). Screening for IR is an important aspect of preventative health maintenance in PCOS patients, and all patients deemed high risk. In this episode, we will provide an evidence-based review of the various modalities for IR screening and diagnosis.