TNF and Insulin resistance: It is worth mentioning here that the highest levels of serum TNF-α, IFN-γ, and IL-6 in diabetic patients with kidney failure were associated with the most deleterious effects on insulin resistance and insulin sensitivity, since the nephrotic diabetic patients with kidney failure have the highest value of HOMA-IR and the lowest value of HOMA-IS as compared with diabetic patients without kidney failure and non-diabetic subjects with kidney failure.