J Mol Cell Cardiol. 2026 Oct 24:S0022-2828(26)00161-6. doi: 10.1016/j.yjmcc.2026.10.010. Online ahead of print.
ABSTRACT
Diabetic cardiomyopathy (DCM) is a distinct myocardial disease defined by the existence of abnormal myocardial structure and performance in diabetes mellitus patients without hypertension and coronary artery disease. DCM has been identified as a major cause of heart failure, hospitalisation and cardiovascular mortality with increasing global burden of diabetes. However, there is a large interindividual variation in disease susceptibility, disease progression and response to therapy, highlighting the limitations of conventional management strategies that are applied uniformly. Precision medicine provides a transformational approach through the integration of genomic, molecular, imaging, clinical and lifestyle data to allow for personalized risk assessment, early diagnosis, prognostication and treatment. This review presents the recent advances in the field of precision medicine for DCM with a focus on the molecular pathological mechanisms including metabolic disorders, oxidative stress, mitochondrial dysfunction, inflammation, fibrosis and microvascular injury. We discuss the relevance of genomics, pharmacogenomics, transcriptomics, proteomics, metabolomics, lipidomics and epigenomics in the context of disease heterogeneity and identification of novel therapeutic targets. Emerging biomarkers including circulating microRNAs, non-coding RNAs, inflammatory mediators, fibrosis-related markers and extracellular vesicles are discussed for their potential in personal diagnosis and prognosis. We also consider the increasing role of advanced cardiac imaging, digital phenotyping, wearable technologies, artificial intelligence, and machine learning in enhancing early detection and clinical decision-making. In this review, the therapeutic advances, including sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, anti-fibrotic therapies, mitochondrial-targeted interventions, regenerative medicine, gene therapy, and RNA-based therapeutics, are discussed, with a focus on the precision medicine approach. Finally, we present current challenges in data integration, clinical validation, cost-effectiveness, and ethical issues, and highlight future directions in digital twins, multi-omics integration, and AI-driven personalized cardiology. The combination of these technologies has the potential to revolutionize the prevention and management of diabetic cardiomyopathy and improve cardiovascular outcomes in patients with diabetes.
PMID:42925888 | DOI:10.1016/j.yjmcc.2026.10.010