TGFB1 and Hyperglycemia: There are three major pathways contributing to this process, including the direct activation of cardiac fibroblasts through the transforming growth factor beta (TGF-β) and hyperglycemia [13], as well as the accumulation of advanced glycation end-products (AGEs) under hyperglycemia stress promoting the crosslinking of collagen fiber to stimulate cardiac fibroblasts [14,15,16].