Understanding Diabetic Cardiomyopathy: Insulin Resistance and Beyond

Area of Science:

• Cardiology
• Endocrinology
• Molecular Biology

Background:

• Diabetic cardiomyopathy (DC) is a heart failure syndrome in diabetes mellitus (DM) patients, independent of other risk factors.
• DC is often underdiagnosed due to a prolonged subclinical phase.
• Numerous studies investigate the pathogenic mechanisms underlying DC.

Purpose of the Study:

• To review and summarize current medical literature on the molecular mechanisms, signaling and metabolic abnormalities, and structural/functional changes in DC.
• To elucidate postulated pathogenic mechanisms of DC beyond insulin resistance.

Main Methods:

• Conducted a literature search using terms like 'diabetic cardiomyopathy' and 'heart failure AND Diabetes mellitus'.
• Reviewed reference lists of included studies and relevant systematic reviews.

Main Results:

• Elucidated various postulated mechanisms in DC pathogenesis, including insulin resistance, inflammation, renin-angiotensin-aldosterone system activation, and disrupted protein homeostasis.
• Summarized molecular, signaling, metabolic, structural, and functional abnormalities associated with DC.

Conclusions:

• Diabetic cardiomyopathy is an underrecognized cardiac complication of diabetes mellitus.
• Comprehensive knowledge of DC pathways and mediators can facilitate the development of diagnostic/prognostic markers, screening protocols, and novel therapies.