Do you use the homeostatic model assessment (HOMA) to assess for insulin resistance and change your clinical management of patients?

No. As insulin assays are not standardized nationally, glucose measurements are surprisingly variable across methods and institutions, single measurements of fasting glucose and insulin are somewhat quixotic, and as there is a loose relationship of HOMA measures in individuals and gold-standard measures of insulin sensitivity and secretion, it really does not make sense to hang your hat on the HOMA measurement. It is not really clinically actionable, particularly as a single measurement within a particular institution or lab.

I completely agree with Dr. @Dr. First Last. It doesn't help manage patients.

You can get a pretty good idea about whether the patient has insulin resistance by assessing for the presence of associated clinical factors, e.g. obesity, HTN, high TG, and low HDL.

Medications obviously should be added/intensified based on response to therapy.

I agree that one level may not be helpful but in patients at risk, its is helpful to assess further. I do get referrals for higher insulin . They do mostly have other factors of metabolic syndrome and A1C may not always be abnormal. I have seen blood sugar fluctuations in people with higher insulin levels even sometimes upto 200’s. I consider treatment as necessary. My main focus is lifestyle changes unless I see significantly high sugars. . CGMs have been helpful in people with insulin resistance.