MMP13 and diabetes mellitus: Specifically, DM patients not treated with insulin faced a 4.44-fold increased risk of developing OA.[21] Contrastingly, other research posits that insulin may exacerbate OA by fostering the synthesis of pro-inflammatory agents such as interleukins, TNF-alpha, and MMP-13, which are implicated in OA’s pathogenesis.[22,23] Several reasons may explain these divergent findings.