Pharmacological and Non-Pharmacological Interventions in Diabetes Mellitus: Effects on Epicardial Adipose Tissue

Diabetes mellitus (DM) has emerged as a significant issue for both individual patients and global health. Elevated blood glucose levels lead to complications affecting the cardiovascular system. Due to this fact and the growing population of patients with DM, it is crucial to broaden the knowledge concerning DM pathogenesis, allowing for the prevention and alleviation of organ-specific complications. Nowadays, pharmacological and non-pharmacological approaches are implicated in DM management. Epicardial adipose tissue (EAT) was indicated to modulate the impact of diabetes mellitus on the heart. Emerging evidence indicates that antidiabetic drugs can significantly influence EAT, often independently of their glucose-lowering effects, suggesting additional cardiometabolic benefits. However, not all drug classes, and even agents within the same class, exhibit identical effects on EAT, highlighting that some therapies may be preferred over others for cardiovascular benefit. Lifestyle interventions, commonly recommended to patients with DM, might also target epicardial fat. This article extensively reviews the impact of current DM treatment on EAT and depicts potential mechanisms. It also aims to identify gaps in knowledge and potential future directions. Insights from this work may guide future research and therapeutic strategies aimed at reducing cardiovascular risk in patients with DM.