In patients with diabetes mellitus, heart disease is more common that in the background populations and has a more serious prognosis. The reasons are only partially understood. Whether patients with diabetes mellitus have a more diffuse and pronounced coronary atherosclerosis has been the subject of many investigations with diverging results. However, the larger studies suggest that coronary atherosclerosis is more pronounced and diffuse in diabetics compared with non-diabetic patients. The pathoanatomic picture of the atherosclerotic process seems to be identical in patients with and without diabetes mellitus. A number of structural abnormalities in the intramural vessels and interstitial tissue of the heart have been demonstrated in diabetics. However, similar abnormalities have also been reported in non-diabetic patients. With respect to where "diabetic cardiomyopathy" is a specific entity, the existing data are not confirmative. Whether diabetes mellitus per se induces functional changes in the coronary vascular system leading to myocardial ischaemia and dysfunction is a subject for future investigations.
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