INS and diabetes mellitus: The following reasons may explain the association of TG/HDL-C with pre-DM and T2DM: TG elevated results in increased free fatty acids (FFA), reduced insulin sensitivity [35], and continued exposure to FFA due to TG may reduce AMP-activated kinase protein activity and increase TG accumulation, leading to changes in pancreatic α-cell insulin signaling and hypersecretion of glucagon [36], thereby creating a vicious cycle between TG levels and IR.