Overall, elevated levels of fetuin-A potentially cause impaired glycemic control, IR, and overt T2DM ascribed to fetuin-A mediated blockade of insulin signaling, TLR-4 activation, macrophage migration, and polarization, adipocyte dysfunction, liver lipid deposition, inflammation, and fibrosis, as well as FFA-mediated inflammation of pancreatic beta cells. The gene discussed is INS; the disease is type 2 diabetes mellitus.