Diabetic cardiomyopathy: a comprehensive review of diagnosis, management, and future directions

Abstract Diabetic cardiomyopathy is a growing challenge to global public health. The clinical characteristics are mainly fibrosis, hypertrophy, ventricular dysfunction, cardiac remodelling, and finally, heart failure. This alarming condition is often difficult to diagnose. Routine tests such as echocardiogram, electrocardiogram, and magnetic resonance imaging, along with specialized techniques such as transmitral Doppler, tissue Doppler imaging, and positron emission tomography, help diagnose and offer clearer insight into the condition. Current treatment strategies mainly address this medical condition as a condition secondary to diabetes. The main therapeutic practices involve glucose-lowering drugs such as glucagon-like peptide-1 modulators and sodium‒glucose cotransporter-2 inhibitors, along with other conventional lines of treatment to manage complications. Promising new potential therapeutic methods include gene therapy and noncoding RNA-mediated regulation of disarrayed signalling cascades. In this review, we address the benefits and limitations of the current system in the diagnosis and treatment of diabetic cardiomyopathy as well as the possibilities and advantages of novel techniques. In addition to discussing biomarkers for screening, diagnosis, and drug response for diabetic cardiomyopathy, we also discuss management and prevention strategies, adversities, and quality of life, and provide a brief outlook for research in this area. Graphical abstract