TNF and Insulin resistance: It secretes many immunomodulatory factors and sends inflammatory signals known to cause insulin resistance [37]. In adipose tissue, TNF-α reduces the expression of the insulin receptor and causes a reduction in tyrosine phosphorylation of the insulin receptor, thereby interfering with insulin action [38]. TNF-α also impairs insulin signaling through serine phosphorylation, leading to the development of T2DM.