INS and Hyperglycemia: The main pathogenetic factors involved in the development and progression of diabetic cardiomyopathy include hyperglycemia, systemic insulin resistance, and impaired cardiac insulin metabolic signaling; these factors induce several pathways including vascular endothelial dysfunction, adrenergic activity, impairment of mitochondria calcium (Ca2+) handling, activation of renin–angiotensin system, myocardial ischemia/functional hypoxia, oxidative stress, mitochondria dysfunction, inflammation, endoplasmic reticulum stress and cardiomyocyte death [72, 73].