Nearly every physician is familiar with the concept that patients with diabetes mellitus have a heightened cardiovascular mortality rate.1 Cardiovascular complications are now the leading cause of diabetes related morbidity and mortality.2 It is generally appreciated that the major cardiac complications of diabetes mellitus include the large conduit arteries, epicardial coronary arteries, and the microvasculature. It is also now widely appreciated that the mortality of acute myocardial infarction is greater in patients with diabetes mellitus,3 both at 30 days and one year after infarction. Stress hyperglycaemia with and without diabetes mellitus is associated with an increased risk of in-hospital mortality in patients with acute myocardial infarction.4

What is less appreciated by physicians and still considered somewhat controversial by some cardiologists is the concept that diabetes mellitus affects cardiac structure and function independent of blood pressure or coronary artery disease. There are now considerable experimental, pathological, epidemiological, and clinical data to support the existence of “diabetic cardiomyopathy”. Since the incidence of diabetes mellitus is growing rapidly and is so strongly associated with the development of heart failure,5 it is timely to consider the evidence regarding the concept of “diabetic cardiomyopathy”, since its initial description nearly 30 years ago.6