Diabetic cardiomyopathy (DCM) significantly contributes to cardiovascular complications in diabetes. This study investigated the protective effects of Resveratrol (RES) in combination with evidence-based nursing on DCM and the underlying molecular mechanisms. Eighty elderly patients with type 2 diabetes mellitus (T2DM) and DCM were randomly assigned to a control group or an RES group. The RES group received RES (800 mg/day) along with evidence-based nursing, while the control group received a placebo with nursing care for six months. Clinical indicators, including glucose and lipid metabolism, lactate dehydrogenase (LDH) activity, inflammatory markers, and cardiac function parameters, were evaluated. Additionally, T2DM rat models were used to examine oxidative stress, cells proliferation, fats accumulation, mitochondrial dysfunction, apoptosis and autophagy, while high glucose (HG)-induced H9C2 myocardial cells were used to investigate cellular mechanisms involving the SIRT1/PPAR-α/PGC-1 pathway. RES combined with evidence-based nursing improved glucose and lipid metabolism, reduced LDH activity, decreased inflammatory markers (TNF-α, IL-6), and enhanced cardiac function in T2DM patients with DCM. In rats, RES restored left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) while reducing myocardial apoptosis with lower Bax and cleaved caspase-3 levels and higher Bcl-2 expression, reduced fibrosis and fat accumulation. Additionally, RES alleviated oxidative stress by decreasing reactive oxygen species (ROS) and malondialdehyde (MDA) levels, suppressed myocardial apoptosis, improved mitochondrial function while increasing ATP and superoxide dismutase (SOD) activity as well as enhancing autophagy. SIRT1 inhibitor (EX527) injections in rats reversed the beneficial effects of RES. In HG-treated H9C2 cells, RES improved cell viability, reduced apoptosis, alleviated oxidative stress and enhanced autophagy. RES ameliorates DCM through SIRT1/PPAR-α/PGC-1 signaling pathway in rats and improves efficacy of elderly DM patients in combination with evidence-based care.
