Improved glycemic control reduces microvascular complications in both type 1 and type 2 diabetes. Macrovascular complications predominate in type 2 diabetes, and the effect of tight control here is less clear. Treatment of other aspects of insulin resistance (BP, lipids) significantly reduces cardiovascular morbidity and mortality in type 2 diabetes. Insulin therapy has favorable effects on endothelial function and lipids, especially compared with sulfonylureas. More information is needed on the effects of diabetes pharmacotherapy on cardiovascular outcomes.