Coronary heart disease (CHD) remains the major factor for morbidity and mortality in diabetes. Management objectives—reduction in further events and complications— are identical to those in nondiabetics, as are the treatment strategies: antiplatelet agents, thrombolytics, cardioselective
1-blockers, and angiotensinconverting enzyme inhibitors. Crucial diabetes-specific measures include optimization of glycemic control in both the long-term and acute myocardial infarction (using insulin-glucose infusion, with greatest benefit in patients not receiving insulin before infarction). Other strategies include aggressive lipid lowering and, on current evidence, coronary bypass rather than percutaneous revascularization. However, since even optimal management tends to be associated with poorer outcome than in nondiabetics, underutilization and inconsistent application of recommended therapies remain the key problems in current clinical practice...