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Besides, designing treatment regimen for patients with renal failure would be a preventive strategy for diabetic cardiomyopathy when their state towards DCM incidence is also considered and monitored precisely.

It has been postulated that DCM is marked by asymptomatic diastolic dysfunction referred to as preclinical diastolic dysfunction (DD), followed by systolic damage in diabetics [10].

The initial stage of DCM is asymptomatic marked by LV hypertrophy with normal ejection fraction, followed by stage 2 with noticeable dilatation and reduced ejection fraction, patients with systolic and diastolic dysfunction mediated by contributing factors viz micro-angiopathy, hypertension and myocarditis are considered in stage 3 and the final stage designated as end-stage or refractory heart failure with ischemia, infraction and remodeling [12].

This stepwise progression of DCM has been engendered due to hyperglycemia mediated metabolic dysregulation, ensuing cardiac apoptosis, necrosis, fibrosis, steatosis, hypertrophy and remodeling [13].

Further we discuss on epigenetic changes influencing the structural and functional abnormalities in diabetic cardiomyopathy.

Diabetic cardiomyopathy has been classified into stages (Figure 1), based on ejection fraction and phenotypic changes in left ventricles (LV).

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