Traditional Chinese Medicine for Diabetic Cardiomyopathy: Multitarget Mechanisms and Translational Potential

Diabetic Cardiomyopathy (DCM) is a diabetes-specific cardiac complication characterized by a complex network of pathogenic mechanisms and lacks effective drugs at present. Traditional Chinese Medicine (TCM) offers a holistic and multi-target therapeutic strategy; however, its clinical translation remains challenging. This review provides a comprehensive overview of the current evidence and challenges associated with TCM for DCM, aiming to promote its clinical application and translation.

Preclinical and clinical studies published between 2004 and 2026 were retrieved from Google Scholar, PubMed, ScienceDirect, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Data. The literature search was conducted using the following keywords: "diabetic cardiomyopathy", "DCM", "traditional Chinese medicine", "Chinese herbal formulas", and "active components of Chinese herbs".

Preclinical evidence has demonstrated that both TCM formulas and monomers exert significant cardioprotective effects in DCM. These agents act on multiple key pathogenic pathways, particularly by attenuating oxidative stress, inhibiting fibrosis, alleviating endoplasmic reticulum stress, and modulating gut microbiota dysbiosis, thereby effectively preventing cellular injury and death. However, clinical trials and evidence remain limited.

The multi-target therapeutic profile of TCM closely matches the multifactorial pathogenesis of DCM, representing a potential paradigm shift from conventional single-target interventions. Furthermore, high-quality trials of TCM in other cardiovascular disorders have demonstrated the feasibility of rigorous randomized and blinded study designs, providing a solid methodological foundation for future translational and clinical research on TCM-based therapies for DCM.

TCM provides an innovative therapeutic strategy for DCM by simultaneously intervening in cascaded pathogenic pathways that single-target drugs fail to address adequately. Despite solid preclinical efficacy support, sufficient clinical verification is absent. Conducting high-quality translational research and multicenter randomized controlled trials is critical to translate laboratory outcomes into clinical practice and integrate TCM into standardized DCM treatment regimens.