FIG. 2.

The compensated phase of diabetic cardiomyopathy. During the compensated stage of diabetic CM, excess fatty acids (FA) trigger activation of PPARα and PGC-1α/β, which serve to increase fatty acid oxidation (FAO), triglyceride (TAG) synthesis, and mitochondrial biogenesis. The shuttling of excess FA into TAG prevents increased generation of toxic lipid species such as diacylglyerol (DAG) and ceramides, minimizing lipotoxicity. During this phase, cardiac function remains normal; however, cardiomyocyte reliance on FA oxidation for energy generation is increased. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/ars