TNF-α-mediated inflammation has been shown to trigger insulin resistance by decreasing insulin-mediated uptake of glucose in adipose cells and promoting β-cell apoptosis in the pancreas leading to a decrease in insulin synthesis17; both of these mechanisms can help explain the increased incidence of metabolic syndrome and T2DM seen in patients with TNF-α-mediated inflammatory arthritis. Here, INS is linked to type 2 diabetes mellitus.