Diabetes is emerging as a major source of cardiovascular morbidity and mortality. The atherosclerosis associated with diabetes has a complex etiology with even more complicated manifestations, such as multivessel and diffuse coronary disease. The optimal management of the diabetic patient with multivessel disease poses a special challenge in terms of the selection of the revascularization strategy and medical therapies. In this article, we assess the evidence accumulated to date and discuss ongoing studies that will help better inform this intricate decision-making process.