Abstract: The prevalence of heart failure with preserved ejection fraction is increasing year by year, and although current continuously improved treatment regimens reduce the mortality of patients to some extent, their prognosis is still poor, whereas regimens that target their comorbidities improve the prognosis of patients more. Type 2 diabetes is its most common comorbidity, and the two interact to advance the disease process. Therefore, heart failure with preserved ejection fraction (HFpEF) combined with type 2 diabetes mellitus (T2DM) is a serious pathophysiological disease that endangers human health, while its pathogenesis is also very complex. Recently, it has been shown that epicardial adipose tissue plays an important role in the development of heart failure with preserved ejection fraction and type 2 diabetes. This review focuses on the possible role of epicardial adipose tissue in the management of heart failure with preserved ejection fraction and type 2 diabetes and the recent advances in therapeutic research in the future, with a view to providing insights and expanding the therapeutic repertoire for the clinical treatment of heart failure with preserved ejection fraction and type 2 diabetes.