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Diabetes, as we are becoming keenly aware, is growing to epidemic proportions, and it is incumbent on cardiologists to consider the ‘comparative effectiveness’ of our treatments for its cardiovascular complications. The incidence of death or myocardial infarction (MI) has been found to be five times higher in patients with diabetes compared with those without.1 In 2001, the National Cholesterol Education Program's Adult Treatment Panel 3 classified diabetes as a risk equivalent to established coronary artery disease.2The relative impact of revascularization strategies for multivessel diabetic patients with ischaemic heart disease has been extensively studied, with evidence favouring more complete revascularization with surgery over percutaneous methods. A meta-analysis of 10 percutaneous coronary intervention (PCI) vs. coronary atery bypass graft (CABG) trials conducted before drug-eluting stents (DESs) were introduced confirmed that in multivessel disease patients with diabetes, survival was better with surgery ( Figure 1 ).3 The question of revascularization choice is being revisited now that DESs are widely used.Another pertinent question relates to whether revascularization is needed for stable diabetic patients with ischaemic heart disease. The recently completed BARI 2D Trial showed that there was little to be gained by stenting patients with mild-to-moderate degrees of coronary obstruction and ischaemia.4 However, for patients requiring revascularization, several trials have been performed and are underway to test the question of whether DESs have levelled the playing field with surgery. The CARDia Trial and the diabetic patients in the SYNTAX Trial had similar survival rates treated with DESs or surgery.5,6 The 1-year follow-up is too short to engender confidence, but the early results were encouraging. The FREEDOM Trial, nearing enrolment completion, will be the largest study of … *Corresponding author. Tel: +1 404 851 5728, Fax: +1 404 851 7339, Email: sbking{at}sjha.org;jfranklin{at}sjha.org

Which stent for diabetic patients: the glass half-full or half-empty?