Focusing on Diastolic Dysfunction to Achieve Consensus With the Term Diabetic Cardiomyopathy

Diabetic cardiomyopathy (DbCM) is commonly defined as ventricular dysfunction in a person living with diabetes in the absence of hypertension and/or coronary artery disease (CAD). There is increasing recognition in the field that this is a poor definition to reflect the pathology of DbCM, as many individuals with diabetes (both type 1 and type 2) are often at risk of or have coexisting hypertension or CAD. On the contrary, there is increasing evidence that people living with diabetes, particularly in the early stages of disease progression, often have asymptomatic and subclinical diastolic dysfunction. Herein, we will interrogate the clinical evidence supporting the presence of diastolic dysfunction in people living with either type 1 or type 2 diabetes in the absence of hypertension and/or CAD, and whether diastolic dysfunction should be a central feature in how we clinically define DbCM. Clinical agreement on how we define and interpret the pathology of DbCM is necessary should the field aim to develop specific pharmacotherapies for this disorder. DbCM should not be confused with heart failure with preserved ejection fraction (HFpEF), despite the latter also being characterized by diastolic dysfunction. Nonetheless, it will be imperative to understand whether DbCM can be a precursor toward the progression of HFpEF in people living with diabetes, as that may further reinforce the clinical importance of managing diastolic dysfunction in the population with diabetes.