Diabetic cardiomyopathy: insights into pathophysiology, diagnosis and clinical management

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Diabetes mellitus significantly increases morbidity and mortality, with heart failure (HF) as a primary cause.
• Diabetic cardiomyopathy, characterized by diastolic dysfunction, affects a substantial percentage of diabetic patients, often asymptomatically.
• HF in diabetes can stem from various factors including ischemia, hypertension, and intrinsic diabetic effects on the heart.

Purpose of the Study:

• To review the pathophysiology, diagnosis, and treatment of diabetic cardiomyopathy.
• To focus on existing, emerging, and novel therapeutic strategies for diabetic cardiomyopathy.
• To provide practical guidance on managing diabetic cardiomyopathy and associated HF.

Main Methods:

• Systematic review of existing literature on diabetic cardiomyopathy.
• Analysis of current and novel therapeutic agents, including SGLT2 inhibitors, ARNi, finerenone, and GLP-1RAs.
• Discussion of innovative approaches like gene therapy, stem cell therapy, and digital health technologies.

Main Results:

• Over 40% of type 2 diabetes patients exhibit diastolic dysfunction; 16% of type 1 diabetes patients show systolic or diastolic dysfunction.
• Early diabetic cardiomyopathy progresses to symptomatic HF through cardiomyocyte hypertrophy, death, and fibrosis.
• Recent advances include SGLT2 inhibitors, ARNi, finerenone, and GLP-1RAs, with potential roles in HF prevention and treatment.

Conclusions:

• While no specific treatment for diabetic cardiomyopathy exists beyond general HF management, novel therapies offer significant promise.
• SGLT2 inhibitors, finerenone, and GLP-1RAs may play a role in preventing HF in asymptomatic diabetic cardiomyopathy.
• Future directions include gene/stem cell therapies and digital technologies for enhanced management of diabetic cardiomyopathy.