Non-Coding RNAs in Diabetic Cardiomyopathy: Mechanistic Insights, Diagnostic and Prognostic Potential, and Therapeutic Perspectives

Diabetic cardiomyopathy (DCM) is a serious complication of diabetes mellitus characterized by ventricular hypertrophy, fibrosis, and impaired cardiac function independent of other cardiovascular diseases. Emerging evidence highlights the critical role of non-coding RNAs (ncRNAs), including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), in regulating key pathological processes such as cardiac hypertrophy, apoptosis, oxidative stress, inflammation, and mitochondrial dysfunction. Although a large and rapidly growing number of individual studies have examined the mechanistic, diagnostic, prognostic, and therapeutic roles of ncRNAs in DCM, this evidence remains scattered across the literature, and no single synthesis has yet integrated these four dimensions specifically for DCM; this review was therefore undertaken to consolidate current mechanistic knowledge of ncRNAs in DCM pathogenesis and to critically evaluate their diagnostic, prognostic, and therapeutic potential, to guide future biomarker validation and therapeutic development. Specific ncRNAs exhibit diagnostic and prognostic potential due to their stability and tissue-specific expression patterns. Furthermore, modulation of dysregulated ncRNAs has shown promise in improving cardiac function in experimental models. These findings suggest that ncRNAs may serve as novel non-invasive biomarkers and therapeutic targets for the effective management of DCM, although further large-scale validation is required before clinical translation.