The editors of Diabetes, Diabetes Care and Diabetologia convened an expert forum before EASD 2025, and its report was published on 28 September 2026. It argues that insulin resistance differs between tissues, between people and within the same person over time, and that some of it is adaptive rather than harmful.
The forum reviews how insulin resistance is measured, from the clamp to surrogate indices, and notes that most current drugs improve it only indirectly, through weight loss or reduced glucose toxicity. It calls for pathway-specific research and for true insulin-sensitising agents.
This is a narrative expert review, not a trial. Its clinical value is as a caution against treating a single surrogate number as a diagnosis.
- Treat HOMA-IR and similar indices as research tools; they are not validated to guide individual treatment.
- Focus on the treatable drivers: weight, physical activity, sleep and liver fat.
- Remember that pioglitazone is the main available drug acting directly on insulin sensitivity.
- Explain to patients that insulin resistance varies by organ, which is why exercise and weight loss help different people differently.
Why it matters
It questions the habit of ordering fasting insulin and HOMA-IR as if they identify one treatable condition.
Don't overread it
This is an expert opinion review; it does not change any treatment recommendation.
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