The increased prevalence of obesity, diabetes and cardiovascular risk factors in people hospitalized with severe COVID-19 illness has engendered considerable interest in the metabolic aspects of SARS-CoV-2-induced pathophysiology.

In this paper published in Cell Metabolism are updated concepts informing how metabolic disorders and their comorbidities modify the susceptibility to, natural history and potential treatment of SARS-CoV-2 infection, with a focus on human biology.

New data informing genetic predisposition, epidemiology, immune responses, disease severity and therapy of COVID-19 in people with obesity and diabetes are highlighted. The emerging relationships of metabolic disorders to viral-induced immune responses and viral persistence, and the putative importance of adipose and islet ACE2 expression, glycemic control, cholesterol metabolism, and glucose- and lipid-lowering drugs is reviewed, with attention to controversies and unresolved questions.

Rapid progress in these areas informs our growing understanding of SARS-CoV-2 infection in people with diabetes and obesity, while refining the therapeutic strategies and research priorities in this vulnerable population.