On the other hand, periodontitis may determine a chronic overexpression of proinflammatory mediators (e.g., IL-1ß, IL-6, and TNF-α) which can induce the production of acute phase reactants by the liver (e.g., c-reactive protein and fibrinogen), lower the production of insulin in the pancreas, and lead indirectly to insulin resistance and hyperglycemia [20]. Here, TNF is linked to Hyperglycemia.