Diabetic patients have an increased risk of cardiovascular disease (CVD), which is a major contributor to morbidity and mortality in the aging population, and have a more than twofold increase in the risk of dying from CVD. 1 Even patients with pre-diabetes, as detected by abnormal glucose tolerance tests, have an increased risk of developing disabling stroke, peripheral artery disease, and myocardial infarction. Healthcare spending for people with diabetes is more than double the expenditure on those without diabetes, and a significant part of these costs is explained by CVD comorbidity. This article will focus on the effect of diabetes on the initiation and progression of arterial occlusive disease, preceded by a short outline of the enormous impact of this issue from a societal-economic perspective.