Some of the potential pathways by which PM2.5 could increase insulin resistance are endothelial dysfunction or vasoconstriction caused by oxidative stress, stimulation of the sympathetic nervous system, and/or the creation of a systemic pro-inflammatory state (e.g., by releasing the cytokines tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6)), among other pathways previously discussed elsewhere (Brook and Rajagopalan, 2009; Rajagopalan and Brook, 2012; Rao et al., 2015). Here, TNF is linked to Insulin resistance.