Both coronary heart disease and diabetes mellitus have high morbidity and mortality rates and pose a continuous challenge to human health in modern society. Improving risk awareness of coronary heart disease and diabetes and enhancing optimal management of medications and hemodynamic reconstruction measures for coronary heart disease combined with diabetes are important to reduce cardiovascular morbidity and mortality and maximize patient prognosis. I. Risk assessment The proportion of coronary artery disease combined with diabetes is high, with about 25% of coronary artery disease patients over 35 years of age in the United States having combined diabetes. Diabetes mellitus is an important and independent risk factor in predicting the prognosis of coronary heart disease. The risk of coronary heart disease in diabetic patients has been shown to be 2-4 times higher than in non-diabetic patients, and about 75% of deaths in diabetic patients are caused by coronary ischemia. The risk of death is significantly higher and the risk of sudden cardiac death is 3 times higher in patients with diabetes than in those without diabetes, and the risk of death during hospitalization is also 2-3 times higher in those with acute myocardial infarction than in those without diabetes. In addition, diabetes increases not only the difficulty and complexity of interventional procedures, but also the occurrence of coronary artery entrapment, perforation, no or slow flow, bleeding, contrast renal injury, in-stent thrombosis, and restenosis, which are independent risk factors for predicting interventional complications in coronary artery disease. In conclusion, coronary artery disease combined with diabetes mellitus is not the sum of two diseases in a simple sense; they have a synergistic effect of 1+1 greater than 2 in increasing the rate of cardiovascular events and mortality, so it is important to fully understand the risks of coronary artery disease combined with diabetes mellitus and to enhance the optimal management of medications and hemodynamic reconstruction measures to minimize cardiovascular morbidity, mortality and improve prognosis. Second, the management of metabolic disorders Diabetes and coronary heart disease have a common etiology, both have metabolic disorders, both are related to a sedentary lifestyle, hypertension, obesity, lipid metabolism disorders, insulin resistance and other cardiovascular metabolic risk factors; there is chronic inflammation and oxidative stress in the pathogenesis, in other words, diabetes and coronary heart disease have a common pathogenic soil. Third, the management of platelet dysfunction Platelet activation and aggregation are increased in diabetic patients, which is related to metabolic abnormalities such as hyperglycemia, insulin resistance and dyslipidemia triggered by diabetes, cellular abnormalities, endothelial function disruption and thrombus-prone environment. It has been shown that in patients with diabetes, there is increased expression of platelet surface receptors P2Y, P2Y12, GPIb, GPIIb/IIIa, and P-selectin; there is also an increase in intracellular calcium ion concentration, which increases platelet degranulation and aggregation; in addition, diabetes also increases oxidative/nitrification stress, which decreases the antioxidant activity of platelets, which further contributes to platelet activation and aggregation. These aforementioned factors not only increase the risk of coronary artery disease, but are also associated with the occurrence of acute coronary events and in-stent thrombosis in diabetes. Therefore, patients with coronary artery disease combined with diabetes mellitus should have more intensive platelet management. IV. Choice of hemodynamic reconstruction strategy 1. Interventional treatment Regarding the clinical effect of coronary intervention, clinical studies of both balloon dilation, bare metal stents and pharmacological stents have shown that diabetic patients are inferior to non-diabetic patients, which is related to the faster rate of coronary lesions, smaller vessel diameter and higher incidence of in-stent thrombosis and stent restenosis in diabetic patients. 2. Coronary artery bypass grafting Coronary artery bypass grafting (CABG) is superior to balloon angioplasty and bare stent interventions in patients with coronary artery disease with multivessel disease, as was consistently concluded in earlier studies such as BARI, ARTS, CREDO-KYOTO, RITA-1, and EAST. However, the era of pharmacological stenting has led to a substantial reduction in the rate of in-stent restenosis and rehematologic reconstruction; therefore, several studies have re-evaluated the effectiveness of coronary artery bypass grafting in recent years. 3. Comparison of interventional therapy and coronary artery bypass grafting Because of the diffuse, complex and rapidly progressing coronary lesions in diabetic patients and the high rate of restenosis and revascularization after interventional therapy, it has long been believed that patients with coronary artery disease combined with diabetes are better off with coronary artery bypass grafting than with interventional therapy, as reflected in several current coronary interventional guidelines.