The hallmark of type 2 diabetes mellitus (T2DM) is abnormal glucose homeostasis due to hyperglycaemia or insulin resistance. Metabolic abnormalities in T2DM lead to cellular dysfunction and the development of diabetic cardiomyopathy and heart failure. New antihyperglycemic agents, such as glucagon-like peptide-1 receptor agonists and the sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown to attenuate endothelial dysfunction at the cellular level. In addition, they showed cardiovascular safety and cardioprotective effects. How these drugs exert their cardioprotective effects is unknown, although recent studies show that cardiovascular homeostasis occurs through the interplay of the sodium hydrogen exchangers (NHE), specifically NHE1 and NHE3 with SGLT2i. Another theoretical explanation for the SGLT2i cardioprotective effects is through natriuresis by the kidney. This theory highlights the possible involvement of renal NHE transporters in the management of heart failure. This review outlines possible mechanisms predisposing to diabetic cardiomyopathy and discusses the interaction between NHE and SGLT2i in cardiovascular disease.

Objective: The heart sound signals captured via a digital stethoscope are often distorted by environmental and physiological noise, altering their salient and critical properties. The problem is exacerbated in crowded low-resource hospital settings with high noise levels which degrades the diagnostic performance. In this study, we present a novel deep encoder-decoder based denoising architecture (LU-Net) to suppress ambient and internal lung sound noises. Methods: Training is done using a large benchmark PCG dataset mixed with physiological noise, i.e., breathing sounds. Two different noisy datasets were prepared for experimental evaluation by mixing unseen lung sounds and hospital ambient noises with the clean heart sound recordings. We also use the inherently noisy portion of the PASCAL heart sound dataset for evaluation. Results: The proposed framework showed effective suppression of background noises in both un?seen real-world data and synthetically generated noisy heart sound recordings, improving the signal-to-noise ratio (SNR) level by 5.575 dB on an average using only 1.32 M parameters. The proposed model outperforms the current state-of-the-art U-Net model with an average SNR improvement of 5.613 dB and 5.537 dB in the presence of lung sound and unseen hospital noise, respectively. LU-Net also outperformed the state-of-the-art Fully Convolutional Network (FCN) by 1.750 dB and 1.748 dB for lung sound and unseen hospital noise conditions, respectively. In addition, the proposed denoising method model improves classification accuracy by 38.93% in the noisy portion of the PASCAL heart sound dataset. Conclusion: The results presented in the paper indicate that our proposed architecture demonstrated a robust denoising performance on different datasets with diverse levels and characteristics of noise. Significance: The proposed deep learning-based PCG denoising approach is a pioneering study that can significantly improve the accuracy of computer-aided auscultation systems for detecting cardiac diseases in noisy, low-resource hospitals and underserved communities.