TNF and Myocardial fibrosis: Stimulated by prolonged hyperglycemia, pro-inflammatory macrophages and lymphocytes accumulate and infiltrate into the heart, promoting the secretion of cytokines, such as tumor necrosis factor (TNF), IL-6, IL-1β, interferon-γ (INF-γ), and transforming growth factor-β (TGF-β), which can induce or exacerbate cardiac injury, leading to further adverse remodeling and myocardial fibrosis [39–42].