Diabetes has become a public health crisis. With the incidence of obesity rising in the United States, the number of diabetics will grow considerably. Of greatest concern is the impact this trend will have on cardiovascular disease. Diabetics demonstrate accelerated coronary atherosclerosis, and the prognosis is worse following cardiac events. Moreover, our interventions have achieved uneven success in treating this subset of patients. This paper will review the metabolic abnormalities that promote atherosclerosis in diabetics and the current methods for treating and preventing the development of coronary artery disease in diabetics, principally through a combination of medications and revascularization.