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Furthermore, both obesity and diabetes are accompanied by significant increases in ROS and decreases in NRF2 and GPX4 levels, indicating a weakening of antioxidant capacity and activation of the ferroptosis process

There are several processes which are fundamental to DCM progression that also involve the proteome of the myocardium that will be altered in structure and quantity as a response to the diabetes-induced tissue damage in the heart (111)

Upon oxidation, cardiolipin migrates to the outer membrane, where it can come into close contact with amyloidogenic proteins in the cytoplasm

In diabetic nephropathy, depletion of endogenous polyamines contributes to podocyte injury, whereas exogenous spermine restores podocyte integrity by activating autophagy via the AMPKmTOR pathway, reducing apoptosis and glomerular damage 120

DOI: 10.1016/j.jdermsci.2018.04.001