INS and hyperinsulinism: As a result, VAT accumulation can expose the liver to high concentrations of free fatty acids and glycerol, which will lead to reduced uptake of insulin by the liver (aggravating hyperinsulinemia), increased triglyceride-rich lipoproteins, and excessive stimulation of hepatic gluconeogenesis, ultimately increasing the risk of T2DM and hyperglycemia (8, 39, 40).