Diabetic cardiomyopathy revisited: The interplay between diabetes and heart failure

Diabetic cardiomyopathy is a complex condition characterized by structural and functional changes in the heart, which are not explained by other known cardiovascular risk factors in patients with diabetes. Since Rubler first described this condition in 1972, there has been significant progress in understanding the multifactorial mechanisms that contribute to the development and progression of heart failure in diabetic patients. In this review, we provide a comprehensive discussion of the key mechanisms that underlie the development of diabetic cardiomyopathy, including chronic hyperglycemia, autonomic neuropathy, altered substrate utilization, and dysregulated insulin pathways. We also compare the distinct characteristics of heart failure in type 1 and type 2 diabetes and review the effects of antidiabetic medications on heart failure in diabetic patients with a particular emphasis on ongoing clinical trials.