EDN1 and Hyperglycemia: In summary, evaluating the degree of cardiac fibrosis using non-invasive imaging techniques and reversing cardiac fibrosis using precision therapeutic strategies that eliminate cardiac fibrosis by blocking the activation of the ROS system, AGE-mediated ET-1, the ECM receptor pathway, or the TGF-β pathway induced by hyperglycemia in DM cardiomyopathy can help improve LV diastolic function and prevent the progression of HFrEF in patients with DM cardiomyopathy (Figure 3).