Among patients with IHD, the presence of concomitant diabetes mellitus increases the risk of adverse events, irre- spective of whether the patient is treated medically or with revascularization. Two studies have suggested that survival among patients with diabetes mellitus is more favorable after bypass surgery than with medical therapy, although these results are based on subgroup analyses from observational data.991,1175 Of 2 studies comparing PCI and medical therapy in patients with diabetes mellitus, one reported longer sur- vival,1175 but the other did not.991 A subgroup analysis of data from the BARI trial suggested that patients with diabetes mellitus who underwent CABG with 1 arterial conduit had improved survival compared with those who underwent PCI.368 Several retrospective cohort studies have compared outcomes among patients with diabe- tes mellitus undergoing PCI versus CABG. Three observa- tional studies have reported a survival advantage for CABG over PCI, whereas a fourth found no significant difference, and no studies located reported better outcomes after PCI. In the BARI 2D study, 2368 patients with type 2 diabetes mellitus and SIHD were initially selected as candidates for either PCI or CABG on the basis of clinical and angiographic assessment and then were randomly assigned to undergo either prompt revascularization with intensive medical ther- apy or intensive medical therapy alone and to undergo either insulin-sensitization or insulin-provision therapy.408 The study was not designed to compare PCI with CABG. At 5 years, overall survival was similar between the revasculariza- tion and medical-therapy groups (88.3% versus 87.8%), as was the incidence of MACE (77.2% versus 75.9%).409 Pa- tients with the most severe CAD were assigned to the CABG stratum and those with the least severe CAD to the PCI stratum. 