These invading cells and cardiomyocytes produce proinflammatory cytokines such as interleukin (IL)-1, IL-18, and the tumor necrosis factor (TNF).42 These proinflammatory cytokines not only stimulate the expression of CAMs as a positive feedback mechanism, but also have direct and indirect cardiodepressive effects such as apoptosis via the intracellular serine-threonine kinase Akt pathway and modulation of cardiac function.43 Hyperglycemia worsens the mitochondrial generation of ROS and glucose oxidation, thereby causing DNA damage and contributing to accelerated apoptosis.8 Here, TNF is linked to Hyperglycemia.