Figure 2.

Clinical manifestations and complications of diabetes or obesity and COVID-19

In the white adipose tissue of individuals with obesity, adipocytes are hypertrophic and the tissue is infiltrated with proinflammatory immune cells that secrete cytokines, chemokines, and adipokines, leading to a permanent inflammatory phenotype. In diabetes, insulin resistance also leads to an increased infiltration of M1 macrophages into adipose tissue. Following infection with SARS-CoV-2, this chronic inflammation might aggravate COVID-19 symptoms in a synergy effect, resulting in metaflammation and a cytokine storm, which contribute to severe COVID-19.