Diabetes is an important risk factor for ischemic heart disease and stroke, the latter two together causing an estimated 12.9 million deaths worldwide in 2010, an alarming statistic, and how to deal with diabetes has become a major public health issue. One of the main goals of treating diabetes is to prevent or reduce the occurrence of chronic complications of diabetes, especially cardiovascular and cerebrovascular pathologies. So the question arises, which drugs are more effective? Aspirin has been around for 100 years and is recognized as a cornerstone in the prevention and treatment of cardiovascular and cerebrovascular events, and even sugar lovers are familiar with it. Does every glucose patient need to take aspirin? What are its side effects? If today we will talk about these questions. The vast majority of cardiovascular events in glucose patients are related to thrombosis, and platelet function plays an “important role” in the evolution of the disease. The production of thromboxane is significantly increased in diabetic patients, and aspirin inhibits platelet synthesis of thromboxane by blocking cyclooxygenase, thereby inhibiting platelet aggregation and preventing thrombus formation. Although aspirin can prevent thrombosis and reduce the occurrence of cardiovascular events, it can lead to an increased risk of bleeding, so it is important to weigh the benefits and risks of aspirin. To standardize the use of aspirin, the American Diabetes Association, in conjunction with the American College of Cardiology, issued a statement in 2010, “The Use of Aspirin in the Primary Prevention of Cardiovascular Events in Patients with Diabetes”. The core of the statement is to first assess cardiovascular risk in the diabetic population, fully consider the risk/benefit ratio, and ultimately determine which patients with diabetes are appropriate to take aspirin for primary prevention of cardiovascular disease. What is primary prevention? In layman’s terms, it is prevention before it happens, as the saying goes: “The best doctors treat the disease before it happens. It is a preventive strategy to avoid or reduce the occurrence of cardiovascular events by intervening early in the disease before it occurs. According to the overall cardiovascular risk, the risk of developing cardiovascular disease can be divided into high risk, medium risk and low risk. High-risk groups are men >50 years of age or women >60 years of age with a combination of any of the following risk factors (family history of cardiovascular disease, hypertension, smoking, dyslipidemia, or proteinuria) with a cardiovascular risk of more than 10% over 10 years; intermediate-risk groups are men >50 years of age or women >60 years of age with no risk factors, and men <50 years of age or women <60 years of age with a combination of any of these risk factors. The risk of cardiovascular disease over 10 years ranged from 5% to 10% for men <50 years of age or women <60 years of age without risk factors; the risk of cardiovascular disease over 10 years was less than 5% for the low-risk group of men <50 years of age and women <60 years of age without risk factors. The 2013 edition of the Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes, taking into account data from studies in Chinese patients with diabetes, states that, after fully weighing the benefit/risk ratios of patients in different risk classes, primary prevention with low-dose (75-150 mg per day) aspirin should be routinely administered to those at high cardiovascular risk, provided there is no significant risk of bleeding (previous history of gastrointestinal bleeding, gastric ulcer, or recent use of drugs that increase bleeding). The decision to use aspirin for primary prevention should be based on clinical judgment in those at intermediate cardiovascular risk. Aspirin should not be routinely used in low-risk groups because the potential risk of bleeding with aspirin in such patients may offset the cardiovascular benefit. In addition, clopidogrel (75 mg daily) may be considered as an alternative treatment for diabetic patients with preexisting cardiovascular disease who are allergic to aspirin. In conclusion, it is important not to generalize about the various issues regarding the use of aspirin in glucose patients, but to weigh the pros and cons to maximize the benefits of thromboprophylaxis and bleeding risk, and glucose patients need to cooperate with their clinicians in cardiovascular risk assessment before determining whether aspirin is appropriate.