FIGURE 1.

Characteristics of heart failure in diabetes. (A) Long-time diabetes is associated with structural remodeling, fibrosis and increased myocardial stiffness in the heart, which lead to the development of HFpEF as well as increased risk for atrial fibrillation. (B,C) On the cellular level, insulin-mediated glucose uptake in healthy cardiomyocytes is of key importance for metabolic flexibility and efficient ATP production (B); insulin resistance strongly impairs metabolism and homeostasis in cardiomyocytes, resulting in reduced ATP production and increased inflammation and apoptosis (C).