Practical approach to the management of diabetic cardiomyopathy: From molecular pathways to treatment strategies

Diabetic cardiomyopathy (DCM) has emerged as a major health challenge, further intensified by the rising global prevalence of type 2 diabetes mellitus. It plays a key role in the morbidity and mortality linked to diabetes, mainly through myocardial dysfunction that develops independently of coronary artery disease or hypertensive heart disease, and it is a major contributor to heart failure. Despite the significance of DCM, there is no gold standard diagnostic test; rather, a multimodal approach is required that includes clinical evaluation (risk factors, and symptoms and signs), cardiac imaging techniques, and biomarkers. The integration of all evaluations may ultimately allow for earlier identification and improved outcomes through timely intervention. In addition, there is scarce evidence on treatment of DCM. The conventional treatment approach is primarily focused on achieving glycemic control, managing cardiac dysfunction, and reducing cardiovascular events using therapies extrapolated from diabetes and heart failure guidelines, rather than targeting the underlying pathophysiological mechanisms. On the other hand, beyond pharmacological approaches, lifestyle modifications, particularly exercise and dietary interventions, could play an important role in the management of DCM due to the associated cardiometabolic benefits in patients with diabetes. In this review, due to the urgent need of clarification for the specific management of DCM and the lack of consistent evidence, we provide a practical updated overview from the pathophysiology to current and future treatment strategies. By integrating this knowledge, we aim to summarize the diagnosis and therapeutic approach that could effectively mitigate or prevent the progression of DCM.