Metabolic Score for Insulin Resistance (METS-IR)

The Metabolic Score for Insulin Resistance (METS-IR) is a non–insulin-based surrogate marker of insulin resistance derived from routine metabolic parameters (fasting glucose, triglycerides, BMI, and HDL-C) that has been studied across largely Latin American, Asian, and United States cohorts. Originally shown to correlate with clamp-measured insulin sensitivity, METS-IR has been associated with cardiometabolic outcomes including incident type 2 diabetes, hypertension, kidney disease, stroke, ischemic heart disease, heart failure outcomes, coronary artery calcification, major adverse cardiovascular events, and both cardiovascular-related and all-cause mortality. Collectively, the literature supports METS-IR as a practical and inexpensive adjunctive marker for approximating insulin resistance. However, a significant methodological limitation is that most studies rely on population-based percentile comparisons rather than a single validated threshold, which substantially hinders the interpretation of individual patient values in clinical practice.