Diabetes mellitus (DM) is a chronic and complex metabolic disorder and also an important cause of cardiovascular (CV) disease (CVD). Patients with type 2 DM (T2DM) and obesity show a greater propensity for visceral fat deposition (and excessive fat deposits elsewhere) and the link between adiposity and CVD risk is greater for visceral than for subcutaneous (SC) adipose tissue (AT). There is growing evidence that epicardial AT (EAT) and pericardial AT (PAT) play a role in the development of DM-related atherosclerosis, atrial fibrillation (AF), myocardial dysfunction, and heart failure (HF). In this review, we will highlight the importance of PAT and EAT in patients with DM. We also consider therapeutic interventions that could have a beneficial effect in terms of reducing the amount of AT and thus CV risk. EAT is biologically active and a likely determinant of CV morbidity and mortality in patients with DM, given its anatomical characteristics and proinflammatory secretory pattern. Consequently, modification of EAT/PAT may become a therapeutic target to reduce the CV burden. In patients with DM, a low calorie diet, exercise, antidiabetics and statins may change the quantity of EAT, PAT or both, alter the secretory pattern of EAT, improve the metabolic profile, and reduce inflammation. However, well-designed studies are needed to clearly define CV benefits and a therapeutic approach to EAT/PAT in patients with DM.

糖尿病（DM）是一种慢性复杂的代谢性疾病，也是心血管（CV）疾病（CVD）的重要病因。患有 2 型 DM (T2DM) 和肥胖的患者更倾向于内脏脂肪沉积（以及其他部位的过多脂肪沉积），并且内脏脂肪与皮下 (SC) 脂肪组织 (AT) 相比，肥胖与 CVD 风险之间的联系更大。越来越多的证据表明，心外膜 AT (EAT) 和心包 AT (PAT) 在 DM 相关的动脉粥样硬化、心房颤动 (AF)、心肌功能障碍和心力衰竭 (HF) 的发展中发挥作用。在这篇综述中，我们将强调 PAT 和 EAT 在 DM 患者中的重要性。我们还考虑了治疗干预措施，这些干预措施可能对减少 AT 数量和心血管风险产生有益影响。鉴于其解剖学特征和促炎分泌模式，EAT 具有生物活性，并且可能是 DM 患者 CV 发病率和死亡率的决定因素。因此，修改 EAT/PAT 可能成为减少 CV 负担的治疗目标。在 DM 患者中，低热量饮食、运动、抗糖尿病药和他汀类药物可能会改变 EAT、PAT 或两者的数量，改变 EAT 的分泌模式，改善代谢特征，并减少炎症。然而，需要精心设计的研究来明确定义 DM 患者的 CV 益处和 EAT/PAT 的治疗方法。在 DM 患者中，低热量饮食、运动、抗糖尿病药和他汀类药物可能会改变 EAT、PAT 或两者的数量，改变 EAT 的分泌模式，改善代谢特征，并减少炎症。然而，需要精心设计的研究来明确定义 DM 患者的 CV 益处和 EAT/PAT 的治疗方法。在 DM 患者中，低热量饮食、运动、抗糖尿病药和他汀类药物可能会改变 EAT、PAT 或两者的数量，改变 EAT 的分泌模式，改善代谢特征，并减少炎症。然而，需要精心设计的研究来明确定义 DM 患者的 CV 益处和 EAT/PAT 的治疗方法。