Diabetic cardiomyopathy: treatment

This article presents a review of the scientific literature on some key aspects of the current state of the problem of diabetic cardiomyopathy treatment. Measures aimed at reducing insulin resistance, correction of hyperglycemia, dyslipoproteinemia, myocardial metabolism disorders, prevention and treatment of thrombosis, symptomatic therapy of concomitant diseases and syndromes of arterial hypertension, coronary heart disease, heart failure and arrhythmias should be at the forefront of the treatment for diabetic cardiomyopathy. In this direction it is necessary to carry out the following preventive and therapeutic measures: rational nutrition and physical activity; correction of obesity; limiting salt intake to 2–4 g/day; exclusion of smoking, alcohol consumption, products containing caffeine. In particular, the issues are analyzed related to the peculiarities of rational nutrition and physical activity, optimization of glycemic control (insulin and/or insulin secretagogues, glucagon-like peptide-1 analogues, sodium-glucose cotransporter-2 inhibitors); correction of metabolic disorders in the myocardium (drugs that improve the energy status of cells — potential means of energy supply for the survival of ischemic myocardium), metabolic modulators (metabolic drugs — trimetazidine, perhexiline, ranolazine; L-carnitine); restriction of extracellular Ca2+ entry into cells (calcium channel blockers), the use of β-adrenergic receptor blockers; modulation of oxidative stress (alpha-lipoic acid, benfotiamine); administration of long-chain ω-3 polyunsaturated fatty acids; sulforaphane, coenzyme Q10; magnesium. Also, promising ways in the treatment of diabetic cardiomyopathy (mimetic peptides for restoring L-type Ca2+ channels; noncoding microRNAs and long noncoding RNAs) are considered.