TMAO also induces endoplasmic reticulum (ER) stress in the cell line of HEK293 cells through the activation of PERK and FoxO1, leading to potential insulin resistance and, thus, increasing the risk of developing hyperglycemia, metabolic dysfunction, and type 2 diabetes in patients with higher levels of TMAO [53]. The gene discussed is FOXO1; the disease is Insulin resistance.