TNF and type 2 diabetes mellitus: In a small randomized controlled trial (RCT) including 60 patients with T2DM and diabetic nephropathy, silymarin reduced urinary and serum TNF-α level compared with placebo; additionally, a significant correlation was found between changes in urinary albumin-creatinine ratio (UACR) and urinary TNF-α level in silymarin-treated patients [19].