Background: Having in mind that diabetes mellitus (DM) and obesity are some of the greatest health challenges of the modern era, diabetic cardiomyopathy (DCM) is becoming more and more recognized in clinical practice.
Main text: Initially DM is asymptomatic, but it may progresses to diastolic, and then systolic left ventricular dysfunction, which results in congestive heart failure. A basic feature of this DM complication is the absence of haemodynamically sig-nificant stenosis of the coronary blood vessels. Clinical manifestations are the result of several metabolic disorders which are present during DM progression. The complexity of metabolic processes, along with numerous regulatory mechanisms, has been the subject of research which aims at discovering new diagnostic (e.g. myocardial strain with echocardiography and cardiac magnetic resonance) and treatment options. Adequate glycaemic control is not sufficient to prevent or reduce the progression of DCM. Contemporary hypoglycaemic medications, such as sodium-glucose transport protein 2 inhibitors significantly reduce the frequency of cardiovascular complications in patients with DM. Several studies have shown that, unlike the above stated medications, thiazolidinediones and dipeptidyl peptidase-4 inhibitors are associated with deteriora-tion of heart failure.
Conclusion: Imaging procedures, especially myocardial strain with echocardiography and cardiac magnetic resonance are useful to identify the early signs of DCM. Research and studies regarding new treatment options are still “in progress”.