INS and diabetes mellitus: The prevalence of impaired LVGLS (> − 16.65%) was greatest in DM group (48.9%), followed by abnormal HOMA-IR group (42.4%) and normal HOMA-IR group (14.0%, overall p < 0.001; Table 1). Higher HOMA-IR value and serum insulin level were significantly related to decreased LVGLS (r = 0.37 and r = 0.35, both p < 0.001; Fig. 3a, b).