Diabetic Cardiomyopathy

Diabetes mellitus is a major public health problem and represents a huge health concern for the global population. In 2010, 285 million people were affected, and this number is estimated to increase to almost 700 million people by 2040. Type 2 diabetes (T2DM) is a chronic metabolic disorder characterized by hyperglycemia and insulin resistance, also representing one of the major risks for developing heart failure (HF) . In 1974, the Framingham study showed that diabetic patients have a 2–5 times higher risk of developing HF than age-matched, non-diabetic patients, and independent of other comorbidities. This suggests a specific intrinsic mechanism that drives the pathological cardiac remodeling in this population. The United Kingdom Prospective Diabetes Study (Group) indicated an association between the risk of cardiovascular complications and glycemia, observing that for every 1% decrease in HbA1c there was an 18% reduction in myocardial infarction (MI) events. Heart failure is a multifactorial disease in diabetic patients. Both type 1 diabetes mellitus (T1DM) and T2DM are associated with an increase in macrovascular and microvascular dysfunction, resulting in ischemic events and altered vascular permeability . Atherosclerosis and hypertension are often present in diabetic patients and contribute to arteria coronaria disease (CAD) and peripheral vascular disease, both of which affect the guts . However, besides these well-known pathological triggers, diabetes contributes to the event of HF through a more disease-specific sort of mechanisms, which are mostly driven by hyperglycemia, hyperinsulinemia, metabolic changes, and oxidative stress.