TNF and Insulin resistance: Diabetes and insulin resistance significantly raise the risk of microvascular complications, including DN, which involves inflammatory processes triggered by hyperglycemia, leading to cytokine production and NF-κB activation, promoting DN development through gene expression of endothelin-1 (ET-1), vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), IL-6, and TNF-α.