In this study, we found by RNA-seq analysis that retinol metabolism disorder gradually emerged in the hearts of db/db mice with the development of DCM and concluded after a series of experiments that retinol metabolism disorder characterized by Rol overload and atRA deficiency is induced by a decrease in RDH10 and promotes myocardial injury mainly through Rol overload-induced cardiotoxicity and atRA deficiency-induced cardiac lipotoxicity and ferroptosis in the heart in T2DM (Fig. 9a). Here, RDH10 is linked to familial dilated cardiomyopathy.