Although the profound suppression of circulating TRAIL levels in T1DM patients with ketoacidosis and increased daily insulin requirements indicates a possible association between TRAIL and the severity of autoimmune reaction, not all findings of this study support this hypothesis, since there was no difference in TRAIL levels between T1DM patients with and without islet-specific antibodies, and there was no difference between diabetic patients with and without other autoimmune diseases which often coexist with T1DM [23]. Here, INS is linked to type 1 diabetes mellitus.