The development of hyperglycemia leads to generation of reactive oxygen species (ROS), lipid peroxidation, and elevated cardiovascular inflammatory markers. It also increased pro-inflammatory cytokine such as tumor necrosis factor-a (TNFa), interleukin (IL)-6, and IL-1, which ultimately alter the immune system (25,26). TNFa mediates insulin resistance
by interfering with insulin receptor signaling (27) or synthesis and/or translocation of glucose transporter (GLUT)-4 to the plasma membrane (28).