Epidemiologic and clinical studies have reported that the prevalence of heart failure (HF) in diabetes is high, and the prognosis for these patients is very poor. In addition, experimental studies have demonstrated that various mechanisms contribute to the impairment in systolic and diastolic function in diabetes, and HF can develop independent of the presence of coronary artery disease or its associated risk factors. Recent clinical trials demonstrated that the sodium glucose cotransporter 2 (SGLT-2) inhibitors reduced hospitalization for HF in patients with type 2 diabetes with high cardiovascular risk. This symposium is discussing the important issues regarding the pathophysiology and therapeutic strategies for patients with diabetes and HF by the investigators from Japan and US.