Morbidity and mortality related to coronary artery disease (CAD)

remain a great challenge in patients with diabetes mellitus.

Revascularization of CAD is an important therapeutic intervention

owing to its impact on both symptoms and prognosis. The optimal

revascularization strategy continues to evolve due to the advent of

new technologies and improved peri-procedural outcome with

both percutaneous coronary interventions and coronary artery

bypass grafting. Although clinical outcome following coronary

artery bypass is worse in diabetic as opposed to non-diabetic

patients, surgical revascularization tends to be associated with

better outcome in stable patients with multivessel disease and

reduced left ventricular function. The advent of drug-eluting stents

has challenged the supremacy of coronary artery bypass grafting

and has become a valuable alternative to surgery. The safety and

efficacy of drug-eluting stents in the treatment of patients with

diabetes and multivessel disease is currently under investigation in

several ongoing randomized controlled trials. Percutaneous coronary

intervention is the therapy of choice in patients with acute

coronary syndromes, particularly ST-elevation myocardial infarction.

The focus of this review is to present the current evidence,

define the role of percutaneous and surgical revascularization in

the treatment of diabetic patients with CAD, and propose a tailored

approach for clinical decision-making.