Diabetic Cardiomyopathy: Pathophysiology and Novel Therapies

Diabetes mellitus and heart failure have a bidirectional relationship and can affect one another. Ventricular dysfunction that occurs in the absence of coronary atherosclerosis and hypertension in patients with diabetes mellitus is termed diabetic cardiomyopathy. Lipotoxicity, increased oxidative stress and mitochondrial dysfunction are a few of the mechanisms implicated in diabetic cardiomyopathy. Patients with diabetes mellitus undergo cardiac structural changes leading to heart failure. The novel glucose-lowering medication that is now preferred for diabetic patients with heart failure is the SGLT-2 (sodium-glucose cotransporter 2) inhibitor. Emerging targeted therapies are showing beneficial effects but require further evaluation. We review the literature describing the pathophysiology of diabetic cardiomyopathy, cardiac structural changes, along with the novel glucose-lowering therapies and targeted therapies for diabetic cardiomyopathy.