Diabetes mellitus (DM) has ubiquitous presence in Indian subcontinent with overall prevalence of cardiovascular diseases as high as 77% among adult diabetic patients compared with 2–4% in the general population. Conversely DM is preset in 25–30% of patients with acute coronary syndrome (ACS) and in those undergoing coronary revascularization in the developed world. This chapter covers the clinical characteristics, preoperative, revascularization strategies, choice of conduits, pump versus off-pump CABG, and outcomes. Diabetics with cardiovascular manifestations may be asymptomatic, present with atypical symptoms or with ACS. Multiarterial grafting with good preoperative preparation and perioperative care of blood sugar improve overall results of surgical myocarcardial revascularization.