Myocardial infarction is the leading cause of death among persons with diabetes. Recent advances in the understanding and treatment of cardiovascular disease in diabetes have made it increasingly important to tailor therapy when treating this high-risk population. Because patients with diabetes are at significantly higher risk for complications and death from MI, these patients are most likely to benefit from early and aggressive therapeutic intervention. Strong recommendations can be given for the use of beta-blockers, ACE inhibitors, and thrombolysis when indicated in the management of acute MI in the diabetic patient. Acetylsalicylic acid is also likely to be beneficial with little risk of adverse events in this setting. In the absence of more definitive data, cautious use of mechanical intervention in diabetic patients is recommended. The use of intravenous insulin therapy may benefit diabetic patients during the acute phase of MI, but more definitive studies are required before it can be recommended for broad use.