When there is too much glucose in the body, it is broken down by the polyol pathway. The polyol pathway is a specific chemical reaction that converts glucose into other substances. One enzyme that is involved in the first step of this pathway is called Aldose Reductase (AR), which converts glucose to a substance called sorbitol and (eventually) fructose, another type of sugar. xvi

Sorbitol and fructose can damage the heart in many ways. One example is something called oxidative stress. As the name suggests, oxidative stress causes a lot of stress to the heart because of an increase in molecules, called free radicals, that are harmful to important structures in cells. When these structures are harmed, the cells in the heart cannot do their job properly.

Sorbitol and fructose will eventually cause cell death if they are not controlled.xvii The damage that occurs includes heart fibrosis, or “hardening” of the heart. When this happens, the heart becomes less effective at pumping blood to the rest of the body. xviii,xix

If DbCM is not treated, it can become worse and turn into overt heart failure or even deathxx. As a result, a treatment that can prevent the damage from the polyol pathway is neededxxi.