Diabetic cardiomyopathy: Pathophysiology, theories and evidence to date

Figure 1 An overview of myocardial energy substrate utilization. Fatty acids and glucose are the major substrates used for ATP generation. The pyruvate generated from glycolysis is metabolised within the mitochondria to produce the majority of carbohydrate-derived ATP while fatty acids undergo β-oxidation. The majority of myocardial ATP originates from the mitochondria via the Krebs Cycle. A preferential increase of activity in one pathway over the other can result in imbalances in substrate uptake and utilization by the mitochondria[151]. GLUT 1: Glucose Transporter 1; GLUT 4: Glucose Transporter 4; FATP: Fatty Acid Transport Protein; CAC: Citric Acid Cycle; ATP: Adenosine Triphosphate; CPT-1: Carnitine palmitoyltransferase-1; CPT-2: Carnitine palmitoyltransferase-2.