A steady increase in the numbers of diabetic patients in coronary surgery has been recorded over the last years. The causes for these rises are seen mainly in the general demographic development in the western industrialized nations, the epidemic progress and wide spread of diabetes mellitus, and changes in assignment behavior. In the following, the specific risk profile of diabetic coronary patients in heart surgery and tried and tested treatment concepts for this particularly challenging group of patients with reference to most recent study results will be presented. Particularly the peculiarities of coronary heart disease in diabetic patients, the choice of the revascularization method, different operative strategies for diabetic patients with coronary heart disease, and challenges faced at the cardiac surgery intensive care unit are discussed in detail.