TNF and Insulin resistance: Insulin resistance could be considered to be a potential underlying mechanism in prediabetes.[31] Higher uric acid levels can lead to an inflammatory response in pancreatic islet cells, oxidative stress, and increased levels of tumor necrosis factor-α, reducing nitric oxide bioavailability, leading to endothelial dysfunction, further inducing insulin resistance and promoting the development of prediabetes.[10,32,33] In addition, higher insulin levels further reduce uric acid excretion in the kidneys.[29]