Other factors that are involved in tubular hypertrophy are hyperinsulinemia and growth factors such as insulin-like growth factor 1 (IGF1), both related to DM, while this process involves tubular cell proliferation, cell hypertrophy and the development of a senescence-like cellular phenotype with increased secretion of pro-inflammatory cytokines, increased production of growth factors and extracellular matrix and resistance to apoptotic remodeling. Here, IGF1 is linked to Hyperinsulinemia.