Cardiovascular complications are a major cause of morbidity and mortality in patients with diabetes mellitus. Diabetes is a heterogeneous, complex metabolic disorder, and it is unlikely that control of hyperglycemia alone will eliminate the excess of cardiac, cerebral, and peripheral vascular diseases found in diabetic patients. In the care of the diabetic patient, glucose levels should be reduced to normal if possible. In addition, however, it is crucial to evaluate and, if necessary, to correct abnormalities in lipids, blood pressure, and hemostasis. The importance of reducing levels of insulin and insulin resistance is not yet clear. Although many questions remain to be answered, available data strongly suggest that patients with diabetes benefit from more aggressive and comprehensive treatment.