In turn, the accumulation of intrahepatic fat changes the insulin signal at the hepatic level, promoting gluconeogenesis, which then promotes hyperglycemia and increases the risk of T2DM.81 Liver damage caused by fat accumulation is due to several mechanisms including lipotoxicity, increased oxidative stress, endothelial dysfunction, apoptosis, and inflammation. This evidence concerns the gene INS and type 2 diabetes mellitus.