Type 2 Diabetes mellitus (T2 D) is an independent risk factor for
cardiovascular diseases and non-ischemic
heart failure, an underestimated complication of T2 D. Diastolic dysfunction is an early sign of diabetes-related
heart failure preceding its progression to systolic damage. The etiology of
heart failure in these patients has recently been partially unveiled. Along with other mechanisms,
hyperinsulinemia and
hyperlipidemia cause increased myocardial
lipid accumulation and oxidation, which leads to lipotoxicity, oxidative stress, inflammatory response and eventually impaired mitochondrial efficiency,
fibrosis, apoptosis and contractile dysfunction. These myocardial alterations resemble the cellular mechanisms underlying the development of
non-alcoholic fatty liver disease (
NAFLD), a frequent comorbidity of T2 D and another risk factor for
cardiovascular diseases and
heart failure. Control of risk factors, lifestyle intervention and
antihyperglycemic treatment are the recommended treatment for patients with T2 D and
heart failure. While thiazolidindiones and some
dipeptidyl peptidase 4 (
DPP4) inhibitors may be detrimental for patients with
heart failure, recent studies provided evidence for safe use of
glucagon-like peptide 1 (GLP1) receptor agonists and for possible beneficial effects of
sodium glucose co-transporter 2 (
SGLT2) inhibitors on mortality and hospitalization of T2 D patients with
heart failure. Treatment of
NAFLD could also be beneficial for the cardiovascular outcome of patients with T2D-related
heart failure. This article provides a brief summary of the current research on underlying mechanisms, clinical features and recently recommended therapeutic approaches for T2D-related
heart failure.