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To develop cardiac insulin resistance, major factors such as hyperglycemia, hyperlipidemia, oxidative stress, inappropriate activation of sympathetic nervous system and the renin-angiotensin II-aldosterone system (RAAS), and dysregulated secretion of adipokines/cytokines are all significant contributors [139]

Prevalence and impact on quality of life of peripheral neuropathy with or without neuropathic pain in type 1 and type 2 diabetic patients attending hospital outpatients clinics

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These microbial alterations are thought to trigger inflammatory and immune responses by regulating LPS biosynthesis, SCFA production, and carbohydrate metabolism, thereby exacerbating DKD progression ( Figure 4 ) [123]