Diabetes mellitus is associated with an excessive cardiovascular morbidity and mortality. Although one frequently associates cardiac dysfunction with enhanced coronary atherosclerosis in diabetic patients, evidence has accumulated for the existence of a specific "diabetic" cardiomyopathy. Abundant literature evidence supports the concept of myocardial dysfunction separate from epicardial coronary disease in diabetic individuals. The relationship of myocardial dysfunction to the type, duration, and treatment of diabetes awaits further delineation. The relative pathogenic significance of the multiple factors that may alter myocardial performance in diabetic patients similarly awaits further elucidation.