Contemporary Percutaneous Coronary Intervention in Diabetic Patients

Coronary artery disease is a leading cause of morbidity and mortality in patients with type 2 diabetes mellitus. Indeed, diabetic patients often present with silent or atypical symptoms and are more likely to develop complex, diffuse, rapidly progressive, and recurrent atherosclerosis. While current guidelines favor coronary artery bypass grafting in diabetic patients with multivessel disease, advances in percutaneous coronary intervention technology have broadened the range of revascularization options for this high-risk population. Nevertheless, despite major improvements in stent platforms over the past two decades, diabetic patients continue to experience higher rates of in-stent restenosis and adverse cardiovascular events compared to non-diabetics, in part, because of the permanent metallic scaffold. Therefore, novel strategies, including drug-coated balloons, minimize chronic inflammation and eliminate permanent vessel caging, thereby offering promising alternatives in this setting, particularly for lesion subsets typical of diabetic patients. This review discusses the current landscape and future directions of percutaneous coronary revascularization in diabetic patients, outlining the evolution from drug-eluting stents to emerging metal-sparing technologies, and highlighting the persistent challenges in achieving optimal outcomes in this population.