Diabetes and the heart: compromised myocardial function ? a common challenge

The increasing comorbidity of diabetes and congestive heart failure becomes a new challenge for cardiological care. Although diabetic cardiomyopathy shows no unique morphological features, profound alterations are found at the biochemical level. Hyperglycaemia induces maladaptive mechanisms that can interfere with efficacy of cardiac energy metabolism, contractile myofibril function, and excitation-contraction coupling, resulting in cytoskeletal changes and increased neurohormonal activity. Metabolic conditions can induce cardiac remodelling and mechanisms acting in a vicious circle within which heart failure and insulin resistance contribute to each other. The currently available therapies and the future perspectives for management focused on metabolic targets, are reviewed.