Serum levels of TNF-α are increased in patients with newly diagnosed type 1 diabetes compared with those in control subjects (18). Even after β-cell function is completely lost, serum TNF-α levels remain elevated in type 1 diabetes (19), suggesting that the hyperglycemic state is associated with chronic inflammation. Anti-TNF-α agents, including etanercept, have an established role in the treatment of rheumatoid arthritis and other autoimmune conditions. In an adult patient with type 1 diabetes and rheumatoid arthritis, after initiation of adalimumab (monoclonal antibody against TNF-α), fructosamine levels decreased without any reduction in erythrocyte sedimentation rate and C-reactive protein or in insulin usage (20). In another report describing three patients with insulin resistance as measured by the homeostasis model assessment index, chronic treatment with infliximab for either rheumatoid or psoriatic arthritis resulted in significant improvement in insulin sensitivity. One patient with type 2 diabetes reverted to a diagnosis of impaired glucose tolerance and stopped insulin therapy. The authors hypothesized that TNF-α blockade resulted in improved insulin signaling (21).