■Interventional cardiologists are very aware of the additional challenges of treating patients with diabetes. They recognise the likelihood of increased procedural complexity due to more diffuse vascular disease and the reduced certainty of long-term clinical outcomes due to accelerated rates of atheroma progression combined with increased rates of bare metal stent restenosis 1 and stent thrombosis 2 . However despite this solid knowledge base, diabetic patients entering the catheterisation laboratory are commonly treated with remarkably little additional consideration. Many operators decide revascularisation strategies based predominantly on anatomical characteristics and the choice of which type of stent to implant can appear to be arbitrary. In this edition of EuroIntervention, colleagues present comparative IVUS analysis following DES implantation in diabetics 3 and a cost-efficiency analysis of data from comparative randomised DES trials enrolling diabetic patients 4 . When we consider these new data, should we conclude that the outcomes associated with use of alternative DES in diabetic patients are sufficiently diverse to mandate a particular stent for this “special” group of patients? It is easy to forget that DES technology entered our clinical practice less than ten years ago. Initial trial data from randomised trials of focal lesions in larger vessels demonstrated the additional benefits of drug elution compared with bare metal stents 5 . Intravascular ultrasound was an important part of these early DES trials. Measurement of neointimal volume allowed ready comparison of drug efficacy and insights into the moderated healing process. However, there was considerable debate concerning the clinical relevance of differing neointimal volume, the “optimal amount” of neointima and the desirability of stent strut coverage to minimise the risk of stent thrombosis. In their paper Jensen and colleagues show substantial differences in the median volume obstruction in diabetic patients after implantation of either the sirolimus-eluting Cypher stent or the first generation zotarolimus-eluting Endeavour stent (median volume obstruction 0% vs. 13%, respectively) 3 . They also make comparison with their previous similar investigations in diabetic patients undergoing implantation of either the Cypher or the paclitaxel eluting Taxus Express stent (median volume obstruction 0% vs. 7.5%, respectively) 6 . Interest