Abstract

Diabetic cardiomyopathy (DCM) is a distinct myocardial complication of diabetes mellitus, characterized by structural and functional cardiac alterations independent of hypertension and coronary artery disease. Its pathogenesis is complex and multifactorial, with oxidative stress recognized as a central mechanism that interacts with metabolic dysregulation, mitochondrial dysfunction, and chronic inflammation. This chapter synthesizes evidence from experimental and clinical studies to examine the role of antioxidant-associated trace elements in the development and management of DCM. Eight essential trace elements—iron, zinc, copper, selenium, iodine, manganese, molybdenum, and chromium—are highlighted for their involvement as cofactors of key antioxidant enzymes, including superoxide dismutase, catalase, and glutathione peroxidase. Disturbances in the homeostasis of these elements weaken antioxidant defenses, increase reactive oxygen and nitrogen species, and accelerate myocardial injury, whereas adequate levels enhance antioxidant activity, preserve mitochondrial function, reduce inflammation, and limit adverse cardiac remodeling. The dual role of trace elements as both inducers and protectors underscores their importance in understanding DCM pathogenesis and highlights their potential as therapeutic modulators. Future strategies should focus on defining optimal micronutrient ranges, developing evidence-based supplementation protocols, and integrating trace element management with conventional treatments to reduce the burden of diabetic cardiomyopathy.