Diabetes mellitus (DM) is increasingly prevalent worldwide, with a significant link to cardiovascular disease (CVD). CVD is the leading cause of mortality and morbidity in diabetic patients, with higher rates of stroke and myocardial infarction (MI) in those with DM. The relationship between DM and CVD is complex, involving shared risk factors such as obesity, hypertension, and dyslipidemia, as well as biological mechanisms like oxidative stress, endothelial dysfunction, and autonomic neuropathy. These factors increase the risk of CVD in diabetic patients. Effective treatment of DM is crucial to reduce long-term CVD complications. Current treatment recommendations focus on managing CV risk factors, including glycemic control, hypertension, dyslipidemia, and autonomic dysfunction. Glycemic control is a key factor in reducing CVD risk, but the optimal target for HbA1c remains debated. Studies show that tight glycemic control may reduce microvascular complications but not necessarily all-cause or CV-specific mortality. Obesity and hypertension are also major risk factors for CVD in diabetic patients, and weight loss and blood pressure control are recommended. Dyslipidemia is common in DM and increases CVD risk, with statins being the primary treatment. However, the effectiveness of high-dose statins and other lipid-lowering therapies is still under investigation. Cardiovascular autonomic neuropathy (CAN) is common in DM and increases the risk of CV events. Treatment of CAN involves glycemic control, lifestyle interventions, and pharmacological agents. Future research should focus on better understanding the relationship between glycemic control and CVD, as well as the optimal treatment strategies for DM to reduce CVD risk. The role of HDL in CV health is also being studied, with mixed results. Overall, managing CV risk factors in diabetic patients is essential to reduce the burden of CVD.Diabetes mellitus (DM) is increasingly prevalent worldwide, with a significant link to cardiovascular disease (CVD). CVD is the leading cause of mortality and morbidity in diabetic patients, with higher rates of stroke and myocardial infarction (MI) in those with DM. The relationship between DM and CVD is complex, involving shared risk factors such as obesity, hypertension, and dyslipidemia, as well as biological mechanisms like oxidative stress, endothelial dysfunction, and autonomic neuropathy. These factors increase the risk of CVD in diabetic patients. Effective treatment of DM is crucial to reduce long-term CVD complications. Current treatment recommendations focus on managing CV risk factors, including glycemic control, hypertension, dyslipidemia, and autonomic dysfunction. Glycemic control is a key factor in reducing CVD risk, but the optimal target for HbA1c remains debated. Studies show that tight glycemic control may reduce microvascular complications but not necessarily all-cause or CV-specific mortality. Obesity and hypertension are also major risk factors for CVD in diabetic patients, and weight loss and blood pressure control are recommended. Dyslipidemia is common in DM and increases CVD risk, with statins being the primary treatment. However, the effectiveness of high-dose statins and other lipid-lowering therapies is still under investigation. Cardiovascular autonomic neuropathy (CAN) is common in DM and increases the risk of CV events. Treatment of CAN involves glycemic control, lifestyle interventions, and pharmacological agents. Future research should focus on better understanding the relationship between glycemic control and CVD, as well as the optimal treatment strategies for DM to reduce CVD risk. The role of HDL in CV health is also being studied, with mixed results. Overall, managing CV risk factors in diabetic patients is essential to reduce the burden of CVD.