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. Author manuscript; available in PMC: 2016 Mar 1.
Published in final edited form as: Nat Rev Endocrinol. 2015 Dec 18;12(3):144–153. doi: 10.1038/nrendo.2015.216

Table 1. Progression of diabetic cardiomyopathy.

Stage Pathophysiological
events		 Changes in structure
and morphology		 Functional
performance
Early Hyperglycaemia;
downregulation of
GLUT4; increases in free
fatty acid levels; insulin
resistance; impairment
of Ca2+ homeostasis;
activated sympathetic
nervous system		 Very small
pathophysiological
changes in myocytes;
normal left ventricular
mass and wall thickness		 Little or no LVDD
Advanced Cardiomyocyte injury and
death; fibrosis; activated
RAAS; maladaptive
inflammatory response		 Increased left
ventricular mass, wall
thickness and size		 Impairment of
left ventricular
diastolic function
and slightly
decreased
ejection fraction
Late Myocardial fibrosis;
abnormal coronary
microvascular;
severe neurohumoral
activation; inflammatory
response		 Substantial increases
in left ventricular mass,
wall thickness and size		 Impairment of
both diastolic and
systolic function

GLUT4, glucose transporter 4; LVDD, left ventricular diastolic dysfunction; RAAS, renin–angiotensin–aldosterone system.