Diabetes has classically been associated with atherosclerotic cardiovascular disease. However, heart failure is now increasingly recognized as a prevalent and often first cardiovascular complication among patients with diabetes. Investigation of this epidemiological relationship has led to recognition of diabetic cardiomyopathy, or structural heart disease that develops in patients with diabetes and may lead to progressive heart failure independently of coronary artery disease or conventional cardiovascular risk factors such as hypertension. Despite increased awareness, clinical management of this common cardiovascular complication remains challenging, with no consensus on its diagnosis or treatment. The lack of specific therapy has been recognized as an unmet clinical need. In this review, we summarize current understanding of the hallmark metabolic and structural changes of diabetic cardiomyopathy, appraise current tools for diagnosis and staging among patients, and describe the emerging but still preclinical data on therapeutic options.