INS and obesity due to melanocortin 4 receptor deficiency: Obesity and T2D are two prominent metabolic disorders that are closed related to heart failure progression.155,156 Obesity is a condition where the body accumulates excessive adipose tissue,157 whereas T2D is often characterized as a dysregulated glucose homeostasis.158 Both conditions are associated with insulin resistance.159 Insulin is an important regulator of energy metabolism and plays a key role in balancing glucose and fatty acid metabolism.