The Underestimated Diabetic Cardiomyopathy: Its Role in Heart Failure Progression and Implications for Drug Discovery

Diabetes mellitus (DM) is a chronic metabolic disease characterized by hyperglycemia. The main cause of mortality in DM patients is cardiovascular disease. Patients with DM have a higher incidence of developing heart failure (HF), especially due to diabetic cardiomyopathy (DC). At the earlier stage, patients might be asymptomatic, yet it may develop to HF with preserved ejection fraction (HFpEF) as it progresses. However, its essentiality is usually underestimated. DC is portrayed by increased thickness of the ventricular septal and left posterior myocardial wall. Its pathogenesis is complicated and involves numerous pathways initiated by hyperglycemia, insulin resistance, and hyperinsulinemia, which contribute to the cardiac hypertrophy. By recognizing the importance of DC and its pathogenesis, the prognosis can be better comprehended, and new therapeutic targets could be better explored in the future.