Abstract: The prevalence and incidence rates of diabetes are continuously on the rise worldwide. Diabetic cardiomyopathy (DCM) is one of the major cardiac complications of diabetes, often indicated by left ventricular diastolic or systolic dysfunction and possibly associated with heart failure, arrhythmia, cardiac shock, and even sudden death. Although the pathogenesis remains not fully clear, the metabolism of glucose and lipid metabolism, myocardial cells with abnormal energy metabolism, myocardial fibrosis, oxidative stress, and cell death are some possible pathogenic causes. This paper reviews the reported pathogenesis of DCM from cellular, tissue and molecular aspects to provide a basis for clinical prevention and treatment.diabetic cardiomyopathy; pathogenesis; metabolic disorders; myocardial fibrosis