INS and periodontitis: Insulin stimulates visceral adipocytes to take up glucose and synthesize lipids to maintain blood sugar homeostasis.95 However, periodontitis-derived virulence factors can mediate oxidative stress, inflammatory responses, and abnormal secretion of specific adipokines, resulting in impaired insulin signaling, reduced glucose uptake by visceral adipocytes, increased lipolysis, and IR in visceral adipose tissue (Fig. 5).