Ischemic heart disease and heart failure are major contributors to the morbidity and mortality associated with diabetes mellitus. With growing knowledge of how the metabolic derangements of diabetes contribute to the pathogenesis of cardiovascular disease, we must continuously refine our understanding of optimal screening and strategies for prevention and treatment for these interlinked disorders. This article summarizes our current understanding of ischemic heart disease and heart failure in patients with diabetes mellitus, highlighting gaps in our knowledge about the relationship between diabetes and cardiovascular disease. Special consideration is given to new strategies for treating the adverse effects of abnormal glucose metabolism on the cardiovascular system.