**Author details**

*Sudden Cardiac Death*

**148**

**Figure 5.**

*beta; SCD, sudden cardiac death.*

This is due to increased synthesis and a decrease in the activity of glyoxylase-1, the enzyme that metabolizes MGO in the different organs of the body [55]. In the heart, MGO exerts a deleterious effect resulting in death of some cells (apoptosis), enlargement and disarray of the structure of cardiac muscles and other tissues which are associated with an elevation of transforming growth factor beta-1 (TGF-beta-1), which in turn elicits hypertrophy of the heart and infiltration of fibrosis [86]. These processes lead to a derangement in cellular calcium homeostasis (elevated diastolic calcium) followed by DC. The resulting effect is remodeling of the heart so that it can maintain its function to pump blood around the body but not at physiological level [87]. Thus, the pathogenesis of diabetic cardiomyopathy in diabetic patients is multifactorial and complex, eventually leading to an energetically compromised heart with reduced working capacity or heart failure, arrhythmias, and SCD. Luckily, patients now have a number of therapies including

*A flow diagram illustrating the events, starting from the risk factors that lead to sudden cardiac death in diabetes mellitus. ROS, reactive oxygen species; MGO, methylglyoxal; TGF-beta, transforming growth factor-*

non-pharmacological and pharmacological interventions to treat SCD.

Manal M.A. Smail1,2, Frank C. Howarth1 , Jaipaul Singh<sup>2</sup> , Sunil Rupee3 , Khemraj Rupee3 , Carlin Hanoman2,3, Abla Mohammed Ismail4 , Farah Ahmed Sleiman4 , Samar Abdulkhalek<sup>5</sup> and Keshore Bidasee6 \*

1 Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates

2 School of Natural Sciences, University of Central Lancashire, Preston, England, United Kingdom

3 School of Medicine, Faculty of Health Sciences, University of Guyana, Turkeyen, Georgetown, Guyana

4 Corniche Hospital, United Arab Emirates

5 Fatima College for Health Science, United Arab Emirates

6 Department of Pharmacology and Neurosciences, University of Omaha Medical Centre, Omaha, NE, USA

\*Address all correspondence to: kbidasee@unmc.edu

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
