IGF1 and Insulin resistance: Proinflammatory mediator levels are elevated systemically that further facilitates insulin resistance. Advanced glycation end product (AGE) accumulation in diabetic patients may induce an exaggerated monocytic inflammatory response leading to severe periodontitis. Interleukin-1 (IL-1), tumor necrosis factor-α (TNF-α), IL-6, platelet-derived growth factor, and insulin-like growth factor-1 may be produced after AGEs bind to monocyte receptors.