Understanding Diabetic Cardiomyopathy: Insulin Resistance and Beyond

Background: Diabetic cardiomyopathy (DC) is a syndrome of heart failure occurring in patients with diabetes mellitus (DM), independent of other risk factors. It is a relatively underdiagnosed condition with a prolonged subclinical phase. There is an abundance of studies put forward to explain the underlying pathogenic mechanisms observed in this condition. This review aims to summarize the evidence available in contemporary medical literature with regard to the molecular mechanisms, abnormalities in signalling and metabolism and structural and functional abnormalities manifesting as DC. Methods: We conducted a literature search using the terms 'diabetic cardiomyopathy', 'heart failure AND Diabetes mellitus', 'Cardiomyopathy AND Diabetes mellitus'. We searched the reference lists of included studies and relevant systematic reviews. Results: In this review, we elucidate all the mechanisms that have been postulated to have a role in the pathogenesis of DC, in addition to insulin resistance, such as inflammation, renin-angiotensin-aldosterone system activation and deranged protein homeostasis. Conclusions: DC is an underrecognized cardiac complication of DM. A comprehensive knowledge of all the pathways and mediators will aid in the development of diagnostic and prognostic markers, screening protocols and novel management strategies.