As a simple and inexpensive tool, the homeostatic model assessment of insulin resistance (HOMA-IR) for screening early after the diagnosis of hidradenitis suppurativa (HS) shows promise for guiding strategies to prevent or attenuate a common vicious cycle of hyperglycemia, chronic inflammation, and impaired tissue repair, according to a small but compelling case series. 

“This study has important implications for the clinical management of HS by highlighting insulin resistance as an underrecognized and actionable contributor to disease burden,” reported the lead author, Destyni Hubbard, a medical student at Howard University College of Medicine in Washington, DC. 

Hubbard presented the data during the Skin of Color Society (SOCS) Annual Scientific Symposium 2026, held the day before the annual meeting of the American Academy of Dermatology.

Despite the prominent dermatologic manifestations, HS is now widely recognized as a systemic inflammatory disorder associated with upregulation of proinflammatory cytokines and metabolic dysfunction, according to Hubbard, whose study was performed with her mentor, Ginette Okoye, MD, chair of the Department of Dermatology at Howard. 

HOMA-IR: A Sensitive Measure of Insulin Metabolism

HOMA-IR, which measures impaired insulin metabolism and pancreatic function, is considered a more sensitive measure for early detection of disturbed glycemic metabolism, noted Hubbard. 

This difference between HOMA-IR and alternative methods of evaluating metabolic function in HS was supported in a case series of 15 patients, in which several approaches were used to detect insulin resistance.

“HbA1c and the triglyceride-to-HDL [high-density lipoprotein] ratio identified insulin resistance in only about 30% of patients,” reported Hubbard. 

In contrast, insulin resistance identified by HOMA-IR, detected in more than 90% of patients, “demonstrated high sensitivity,” she said.

In this retrospective chart-review study, the metrics for metabolic function evaluated in 15 adult patients with HS were — in addition to HOMA-IR — fasting glucose, fasting insulin, triglycerides, HDL cholesterol, A1c, BMI, and Hurley stage. For insulin resistance, HOMA-IR was calculated with a standard formula. Findings were correlated with fasting insulin and A1c for both normal and elevated levels.

At baseline, the findings included 98.8 mg/dL for fasting glucose, 23.1 m U/mL for fasting insulin, 5.7 for A1c, 38.7 for BMI, and 2.1 for Hurley stage. Of the 15 patients, 14 were women and the mean age was 36.2 years. 

HOMA-IR was correlated strongly with fasting insulin (r = 0.97) but only moderately correlated with A1c (r = 0.49). In fact, A1c was normal in 69% of patients despite high mean levels of fasting insulin and HOMA-IR levels.

“HOMA-IR outperformed traditional markers, revealing a high burden of subclinical insulin resistance that would otherwise go undetected,” Hubbard reported.

Unlike the common delay in the rise of A1c and other metabolic markers in the early stage of insulin resistance, HOMA-IR detects insulin resistance before the onset of hyperglycemia, Hubbard said. She also pointed out that it is “simple and inexpensive.”

The ability of HOMA-IR to detect disturbed glucose metabolism might be particularly useful in HS, a disease that disproportionately occurs in Black patients, Hubbard noted.

High Prevalence of Insulin Resistance in Black HS Patients

“In our predominantly African American cohort, the prevalence of insulin resistance detected by HOMA-IR was substantially higher than previously reported,” Hubbard said.

Although larger studies are needed, she said that these findings provide a basis for considering HOMA-HR routinely in the evaluation of metabolic disturbance in HS patients. She indicated that findings support HOMA-IR screening early in the patient workup.

“Its use may facilitate earlier metabolic screening and support timely interventions such as lifestyle modification, dietary counseling, and consideration of agents like metformin or GLP-1 receptor agonists,” she suggested.

HS is commonly associated with type 2 diabetes, and this is not the first study to consider HOMA-IR as a means of detecting metabolic disturbances likely to be contributing to the chronic inflammation that underlies HS.

In a 2025 study that compared HOMA-IR levels in 95 HS patients to 49 controls with type 2 diabetes, the proportion of HS patients with a level ≥ 2.5, which is typically considered the threshold for insulin resistance, was more than twofold greater (7.3% vs 3.2%; P = .9017).

In prior studies, type 2 diabetes and insulin resistance have been associated with HS, and both are “associated with more severe forms of HS,” reported the authors of this study, which was led by Nessr Abu Rached, MD, International Centre for Hidradenitis Suppurativa, Department of Dermatology, Venereology, and Allergology, Ruhr University, Bochum, Germany.

This relationship between HS, a metabolic syndrome that includes insulin resistance, and metabolic dysregulation that drives a more severe HS phenotype is probably best explained by the proinflammatory effects of this interrelationship, Abu Rached reported.

“Chronic inflammation in HS is linked to significant insulin-glucose dysregulation, particularly in patients with a higher degree of inflammation.” 

Hubbard reported no potential conflicts of interest. Okoye has financial relationships with Incyte, Janssen, Novartis, Sandoz, and UCB. Abu Rached reported financial relationships with Johnson & Johnson and Novartis.