Background: People with type 2 diabetes means they are more likely to progress many complications such as hyperglycemia, low-grade inflammation, insulin resistance, and accelerated heart disease. Diabetic heart disease (DHD) can be diabetic cardiomyopathy, heart failure (HF), and coronary heart disease.
Methods: Blood samples from 100 patients with DHD, and 76 controls included   [diabetic patients without cardiac diseases 56, and 20 healthy individuals were collected. C reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR), vascular cell adhesion molecule (VCAM), B-type natriuretic peptide (BNP), were estimated in all study individuals. The area under receiver-operating characteristic curve (AUC) was used to evaluate the diagnostic accuracy of the single and combined markers. Results: Levels of CRP, BNP, and NLR had significant differences but VCAM had no significant differences among DHD, controls, diabetic, and healthy individuals groups.  Then VCAM marker was excluded from further analysis. CRP was the most efficient biomarker among markers for discriminating DHD patients from healthy individuals, diabetic patients and, controls with AUCs were 0.99, 0.87, and 0.89; respectively. We developed a new model based on three blood markers (CRP, BNP, NLR) for differentiated DHD.  Linear significant correlations were observed between model levels and candidate markers that included: CRP (r=0. 78; p <0.0001), NLR (r = 0. 0.53; p <0.0001), BNP (r = - 0.55; p <0.0001). The AUC of the model was 1.0 with 100 % sensitivity and 100 % specificity for discriminated patients with DHD from healthy individuals. For discriminate patients with DHD from diabetic patients, AUC was 0.90 with 92 % sensitivity and 81% specificity. For discriminate patients with DHD from controls, AUC was 0.93 with 92 % sensitivity and 83 % specificity.  
Conclusion: The combination of three candidate biomarkers CRP, BNP, and NLR can be used to improve the diagnosis of DHD patients with high diagnostic performances.