journal article·2025-09-24Open access

Application of the HOMA Index in Diabetic Dogs and Cats: A Systematic Review of Current Evidence

Luminița Diana Hrițcu, Vasile Boghian, Geta Pavel, Teodor Daniel Hrițcu, Alexandru Spataru, Liviu Cătălin Burtan, Mihaela Claudia Spataru

Applied Sciences· Volume 15· Issue 19

Abstract

The use of the HOMA (Homeostatic Model Assessment) index in veterinary medicine is emerging as a promising and valuable method for evaluating insulin resistance and beta-cell function in companion animals, particularly in dogs and cats. Originally developed for use in human medicine, HOMA enables a minimally invasive assessment of glucose and insulin homeostasis, offering clinicians a practical tool for diagnosing and monitoring diabetes mellitus in animals. Its application in veterinary practice brings several advantages, including cost-effectiveness, ease of use, and the potential for early detection of metabolic disturbances before clinical symptoms appear. Nonetheless, important limitations persist, such as inter-individual variability, the effects of stress and comorbidities on glucose and insulin values, and the absence of standardized, species-specific reference ranges. These factors highlight the need for methodological refinement and the establishment of validated protocols tailored to the unique physiological characteristics of dogs and cats. Despite these challenges, HOMA represents a promising avenue for advancing the understanding of diabetes pathophysiology in veterinary patients. Future longitudinal studies and controlled trials are essential to confirm its reliability and enhance its clinical relevance. With further development, the HOMA index could become an essential tool in improving diagnostic accuracy and optimizing the management of diabetes in companion animal practice.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Veterinary Medicine and Surgery · Diet and metabolism studies · Diabetes and associated disorders

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Clinical Department, Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” Iasi University of Life Science, 700489 Iasi, Romania

Preclinical Department, Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” Iasi University of Life Science, 700489 Iasi, Romania

Public Health Department, Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” Iasi University of Life Science, 700489 Iasi, Romania

Department of Laboratory Medicine, “St. Spiridon” County Emergency Clinical Hospital 1, Independenței Boulevard, 700111 Iași, Romania

Funding

University of Life Sciences “Ion Ionescu de la Brad” Iasi Romania

References (92)

Show source-provided references
1. Canine and feline diabetes mellitus: Nature or nurture?10.1093/jn/134.8.2072S ↗
2. Studying cat (Felis catus) diabetes: Beware of the pitfalls and challenges
3. An epidemiological study of diabetes mellitus in dogs attending first-opinion practice in the UK10.1136/vr.101950 ↗
4. Feldman, E.C., Nelson, R.W., and Reusch, C.E. (2015). Canine Diabetes Mellitus. Canine and Feline Endocrinology, Saunders. [4th ed.].
5. Agreeing Language in Veterinary Endocrinology (ALIVE): Diabetes mellitus—A modified Delphi-method-based system to create consensus disease definitions10.1016/j.tvjl.2022.105910 ↗
6. Rand, J. (2012). Feline diabetes mellitus. BSAVA Manual of Canine and Feline Endocrinology, BSAVA Library.10.22233/9781905319893.13 ↗
7. Evaluation of detemir in diabetic cats managed with a protocol for intensive blood glucose control10.1177/1098612X12446211 ↗
8. Reusch, C.E., Nelson, R.W., and Feldman, E.C. (2015). Diabetic ketoacidosis. Canine and Feline Endocrinology, Elsevier Saunders. [4th ed.].
9. 2018 AAHA Diabetes Management Guidelines for Dogs and Cats10.5326/JAAHA-MS-6822 ↗
10. Hritcu, L.D., Borcea, D., and Burtan, L. (2019). Experimental induction of DM in rats and the role of bariatric surgery for the recovery of pancreatic β cells. J. Biotechnol., 305.10.1016/j.jbiotec.2019.05.261 ↗
11. Canine diabetes mellitus: Can old dogs teach us new tricks?10.1007/s00125-005-1921-1 ↗
12. Feldman, E.C., Nelson, R.W., Reusch, C.E., Scott-Moncrieff, J.C.R., and Behrend, E.N. (2015). Feline Diabetes Mellitus. Canine and Feline Endocrinology, Saunders Elsevier. [4th ed.].
13. Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man10.1007/BF00280883 ↗
14. Use and abuse of HOMA modeling10.2337/diacare.27.6.1487 ↗
15. Current approaches for assessing insulin sensitivity and resistance in vivo: Advantages, limitations, and appropriate usage10.1152/ajpendo.00645.2007 ↗
16. Insulin sensitivity decreases with obesity, and lean cats with low insulin sensitivity are at greatest risk of glucose intolerance with weight gain10.1053/jfms.2001.0138 ↗
17. Assessment and mathematical modeling of glucose turnover and insulin sensitivity in lean and obese cats10.1016/j.domaniend.2005.12.004 ↗
18. Evaluation of beta-cell function in obese dogs
19. Evaluation of the homeostatic model assessment of insulin resistance (HOMA-IR) for predicting the development of diabetes mellitus in cats
20. Insulin sensitivity, fat distribution, and adipocytokine response to different diets in lean and obese cats before and after weight loss10.1152/ajpregu.00313.2006 ↗
21. Spontaneously obese dogs exhibit greater postprandial glucose, triglyceride, and insulin concentrations than lean dogs10.1016/j.domaniend.2011.10.002 ↗
22. Animal models of disease: Classification and etiology of diabetes in dogs and cats10.1530/JOE-14-0202 ↗
23. Classification of diabetes mellitus in dogs and cats: A new approach
24. Mari, A., Tura, A., Grespan, E., and Bizzotto, R. (2020). Mathematical modeling for the physiological and clinical investigation of glucose homeostasis and diabetes. Front. Physiol., 11.10.3389/fphys.2020.575789 ↗
25. Al Ali, H., Daneshkhah, A., Boutayeb, A., Merabet, N., and Mukandavire, Z. (2025). A Comprehensive Review of Mathematical and Data-Driven Models in Glucose Homeostasis and Diabetes Pathways. Computational Mathematics and Modelling for Diabetes, Springer.10.1007/978-981-96-1925-2_3 ↗
26. Experimental induction of type 2 diabetes mellitus and the efficiency of bariatric surgery in its reversal in rats
27. Feline diabetes mellitus: Diagnosis, management, and prognosis
28. Canine diabetes mellitus: From phenotype to genotype10.1111/j.1748-5827.2007.00398.x ↗
29. Nelson, R.W. (2015). Disorders of the endocrine pancreas. Small Animal Internal Medicine, Elsevier. [5th ed.].
30. Basal plasma insulin and homeostasis model assessment (HOMA) are indicators of insulin sensitivity in cats10.1016/j.jfms.2004.12.002 ↗
31. Strage, E.M., Ley, C.J., Forkman, J., Öhlund, M., Stadig, S., Bergh, A., and Ley, C. (2021). Homeostasis model assessment, serum insulin and their relation to body fat in cats. BMC Vet. Res., 17.10.1186/s12917-020-02729-1 ↗
32. Is methylprednisolone acetate-related insulin resistance preventable in cats?10.1016/j.tcam.2022.100648 ↗
33. Feline comorbidities: Pathophysiology and management of the obese diabetic cat10.1177/1098612X211021540 ↗
34. Stockham, S.L., and Scott, M.A. (2024). Fundamentals of Veterinary Clinical Pathology, John Wiley & Sons. [3rd ed.].
35. Chronic elevation of plasma cortisol causes differential expression of predominating glucocorticoid in plasma, saliva, fecal, and wool matrices in sheep10.1016/j.domaniend.2020.106503 ↗
36. Diabetes: Models, signals, and control10.1109/RBME.2009.2036073 ↗
37. Rijnberk, A., and Kooistra, H.S. (2010). Clinical Endocrinology of Dogs and Cats: An Illustrated Text, Schlütersche.
38. Uchańska, O., Ochota, M., Eberhardt, M., and Niżański, W. (2022). Dead or Alive? A Review of Perinatal Factors That Determine Canine Neonatal Viability. Animals, 12.10.3390/ani12111402 ↗
39. Insulin resistance and its determinants in overweight and obese dogs
40. Evaluation of insulin resistance in dogs: HOMA-IR thresholds and clinical implications
41. Nutritional modulation of insulin resistance in the true carnivorous cat: A review10.1080/10408398.2010.499763 ↗
42. Evaluation of beta-cell sensitivity to glucose and first-phase insulin secretion in obese dogs10.2460/ajvr.72.3.357 ↗
43. Body fat percentage, plasma insulin, and glucose concentrations in lean and overweight cats
44. Niessen, S.J.M., Forcada, Y., Mantis, P., Lamb, C.R., Harrington, N., Fowkes, R., Korbonits, M., Smith, K., Church, D.B., and Wolfe, A. (2015). Studying cat (Felis catus) diabetes: Beware of the acromegalic imposter. PLOS ONE, 10.10.1371/journal.pone.0127794 ↗
45. Intensive blood glucose control is safe and effective in diabetic cats using home monitoring and treatment with glargine10.1177/1098612X12446211 ↗
46. Quantitative estimation of beta cell sensitivity to glucose in the intact organism: A minimal model of insulin kinetics in the dog10.2337/diab.29.12.979 ↗
47. Evaluation of insulin resistance in overweight and obese dogs10.17352/ijvsr.000055 ↗
48. Development of a preliminary clinical approach for detecting insulin resistance for normoglycemic control in canine diabetes10.56808/2985-1130.3626 ↗
49. HOMA metabolic assessment in normoglycemic and diabetic canines
50. Evaluation of insulin resistance by HOMA-IR and its relation with obesity in dogs
51. Dhama, K., Latheef, S.K., Dadar, M., Samad, H.A., Munjal, A., Khandia, R., Karthik, K., Tiwari, R., Yatoo, M.I., and Bhatt, P. (2019). Biomarkers in stress related diseases/disorders: Diagnostic, prognostic, and therapeutic values. Front. Mol. Biosci., 6.10.3389/fmolb.2019.00091 ↗
52. Perera, T.R., Skerrett-Byrne, D.A., Gibb, Z., Nixon, B., and Swegen, A. (2022). The future of biomarkers in veterinary medicine: Emerging approaches and associated challenges. Animals, 12.10.3390/ani12172194 ↗
53. Analysis of insulin resistance using the non-linear homeostatic model assessment index in overweight canines
54. Composition of dietary fat affects blood pressure and insulin responses to dietary obesity in the dog10.1002/j.1550-8528.1998.tb00328.x ↗
55. AAHA diabetes management guidelines for dogs and cats10.5326/0460215 ↗
56. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus10.1093/clinchem/hvad080 ↗
57. ++ Diagnostic Usefulness of HOMA-β and HOMA-IR in Diabetes Mellitus—A Review
58. Pathophysiology of insulin resistance in type 2 diabetes
59. Surrogate markers of insulin resistance: A review10.4239/wjd.v1.i2.36 ↗
60. Andonova, M., Dzhelebov, P., Trifonova, K., Yonkova, P., Kostadinov, N., Nancheva, K., Ivanov, V., Gospodinova, K., Nizamov, N., and Tsachev, I. (2023). Metabolic markers associated with progression of type 2 diabetes induced by high-fat diet and single low dose streptozotocin in rats. Vet. Sci., 10.10.3390/vetsci10070431 ↗
61. Assessment of insulin secretion and insulin resistance in human10.4093/dmj.2021.0220 ↗
62. The biochemical assessment of insulin resistance10.1258/000456307780945778 ↗
63. Evaluation of Insulin Resistance in Obese Dogs: Use of the Homeostatic Model Assessment (HOMA)
64. Gottlieb, S. (2024). Diabetic Cats in Remission. [Ph.D. Thesis, The University of Queensland].
65. What do we learn from measurements of HOMA-IR?10.1007/s00125-013-2948-3 ↗
66. Homeostasis model assessment of insulin resistance (HOMA-IR) in the diagnosis of insulin resistance and prediabetes
67. A comparative study of the relationship between time in range assessed by self-monitoring of blood glucose and continuous glucose monitoring with microalbuminuria outcome, HOMA-IR and HOMA-β test10.1016/j.jdiacomp.2024.108831 ↗
68. Should insulin resistance (HOMA-IR), insulin secretion (HOMA-β), and visceral fat area be considered for improving the performance of diabetes risk prediction models10.1136/bmjdrc-2023-003680 ↗
69. Metformin plus low-dose glimeperide significantly improves homeostasis model assessment for insulin resistance (HOMAIR) and β-cell function (HOMAβ-cell) without hyperinsulinemia in patients with type 2 diabetes mellitus10.1097/01.pap.0000249909.54047.0e ↗
70. Association of hypertriglyceridemia with insulin resistance in healthy Miniature Schnauzers10.2460/javma.238.8.1011 ↗
71. Investigations of Insulin Resistance in Obese Dogs
72. Optimal cut-off values for the homeostasis model assessment of insulin resistance (HOMA-IR) and pre-diabetes screening: Developments in research and prospects for the future10.5582/ddt.2015.01207 ↗
73. Madsen, S.M., Thorup, A.C., Overgaard, K., and Jeppesen, P.B. (2015). High intensity interval training improves glycaemic control and pancreatic β cell function of type 2 diabetes patients. PLoS ONE, 10.10.1371/journal.pone.0133286 ↗
74. Challenges in the diagnosis of insulin resistance: Focusing on the role of HOMA-IR and Tryglyceride/glucose index10.1016/j.dsx.2022.102581 ↗
75. Al-Hakeim, H.K., and Abdulzahra, M.S. (2015). Correlation between glycated hemoglobin and homa indices in type 2 diabetes mellitus: Prediction of beta-cell function from glycated hemoglobin. J. Med. Biochem., 34.10.2478/jomb-2014-0033 ↗
76. HB, I.A. (2015). Insulin Resistance and its Significant Co-Morbidities in Young Individuals-Including Homa (Homeostatic Model Assessment). [Doctoral Dissertation, Rajiv Gandhi University of Health Sciences].
77. Effect of acarbose on postprandial blood glucose concentrations in healthy cats fed low and high carbohydrate diets10.1177/1098612X14556559 ↗
78. Verbrugghe, A., and Hesta, M. (2017). Cats and carbohydrates: The carnivore fantasy?. Vet. Sci., 4.10.3390/vetsci4040055 ↗
79. Comparison of a low carbohydrate–low fiber diet and a moderate carbohydrate–high fiber diet in the management of feline diabetes mellitus10.1016/j.jfms.2005.08.004 ↗
80. Kidney function and glucose metabolism in overweight and obese cats10.1080/01652176.2020.1759844 ↗
81. Insulin resistance in cats10.1016/j.cvsm.2009.10.007 ↗
82. Zhao, X., An, X., Yang, C., Sun, W., Ji, H., and Lian, F. (2023). The crucial role and mechanism of insulin resistance in metabolic disease. Front. Endocrinol., 14.10.3389/fendo.2023.1149239 ↗
83. Association of insulin resistance and ectopic fat accumulation with HOMA indices: A Single-Centre observational study
84. Obesity and associated comorbidities in people and companion animals: A one health perspective10.1016/j.jcpa.2017.03.006 ↗
85. Kabu, M., and Tunç, A.C. (2024). Importance and Areas of Use of Biomarkers in Veterinary Medicine Clinical Practice. Current Research and Treatment in Animals, Livre de Lyon. Available online: https://bookchapter.org/kitaplar/Current_research_and_treatment_in_animals.pdf.
86. Patra, S., McMillan, C.J., Snead, E.R., Warren, A.L., Cosford, K., and Chelikani, P.K. (2024). Feline Diabetes Is Associated with Deficits in Markers of Insulin Signaling in Peripheral Tissues. Int. J. Mol. Sci., 25.10.3390/ijms252313195 ↗
87. (2013). In Vitro Diagnostic Test Systems—Requirements for Blood-Glucose Monitoring Systems for Self-Testing in Managing Diabetes Mellitus. Standard No. ISO 15197:2013.
88. (2019). Accuracy (Trueness and Precision) of Measurement Methods and Results—Part 2: Basic Method for the Determination of Repeatability and Reproducibility of a Standard Measurement Method. Standard No. ISO 5725-2:2019.
89. (2014). Standard Test Method for Tensile Properties of Plastics. Standard No. ASTM D638-14.
90. Pöppl, Á.G., Lopes, J.L.X., Nogueira, T.B., Da Silva, D.I., and dos Santos Machado, B. (2024). Estrus Cycle, Pyometra, and Insulin-Resistant Diabetes in the Bitch: What Is Known and Why It Is Relevant?. Preprints, Available online: https://www.preprints.org/manuscript/202402.1006/v1.10.20944/preprints202402.1006.v1 ↗
91. Jagannatha, S.B. (2014). Study of Serum High Sensitivity C-Reactive Protein, Ferritin, Insulin, C-Peptide and Glycated Hemoglobin in Patients with Type 2 Diabetes Mellitus. [Ph.D. Thesis, Rajiv Gandhi University of Health Sciences].
92. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews10.1136/bmj.n71 ↗