Diabetic patients frequently develop heart failure and have a guarded prognosis because of the combination of diabetic cardiomyopathy, hypertension and ischaemic heart disease. The lack of patient awareness of the association between diabetes and cardiovascular disease contributes to the risk of heart failure in the diabetic population. Therefore, physicians should consider the risk of comorbidities and use appropriate screening tests to achieve early identification and initiate preventive strategies. There is evidence suggesting that adequate glycaemic control may improve cardiac metabolism and myocardial function in diabetics with heart failure. Improvement in cardiac function engendered by neurohumoral inhibition is associated with a decrease in mortality that is at least as great in the diabetic patients with heart failure as it is in the non diabetic patients. However, several therapeutic interventions have not yet been specifically validated in diabetic subjects. Thus, physicians should be encouraged to use therapies tested in the diabetic population, such as B-blockers and ACE inhibitors. Diabetic patients would benefit from more aggressive preventive programs aimed at reducing the incidence of cardiovascular morbidity and mortality.