In response to extrinsic (hyperglycemia, free fatty acid, inflammation) and intrinsic (ER stress) stresses (colored red), p53 is activated to trigger pancreatic dysfunction and impair insulin production through several mechanisms. The genes depicted in squares represent transcriptional targets of p53. The genes colored in blue positively contribute to p53 activation, while genes colored in orange inhibit p53-mediated pancreatic dysfunction. Note that the KATP channel only activates p53 signaling in response to excessive ATP. FFA, free fatty acid; ROS, reactive oxygen species.