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Lancet (2017) 389(10086):232837

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The molecular pathogenesis of DCM involves interconnected mechanisms including inflammation, hyperglycemia, insulin resistance, fatty acid dysregulation, oxidative stress, mitochondrial dysfunction, and endothelial dysfunction ( Of particular significance, inflammation emerges during early-stage diabetes and acts as a key driver of DCM progression ( These core mechanisms act synergistically, inducing severe metabolic dysregulation characterized by lipid accumulation (lipotoxicity), progressive mitochondrial impairment, sustained oxidative stress, inflammatory activation, myocardial fibrosis, and enhanced apoptosis

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