In turn, the increased cardiac FGF21 sensitivity induced by endurance exercise prevents diabetic cardiomyopathy by activating the (nicotinamide adenine dinucleotide) NAD+-dependent deacetylase sirtuin-3 (SIRT3) and preserving mitochondrial integrity via the AMPK-(forkhead box protein O3) FOXO3 signaling pathway (Jin et al, 2022). Here, FOXO3 is linked to diabetic cardiomyopathy.