In this trial involving patients with type 2 diabetes and stable ischemic cardiovascular disease, prompt revascularization was compared with medical therapy, and insulin sensitization was compared with insulin provision, with patients stratified according to whether they underwent percutaneous coronary intervention or coronary-artery bypass grafting. Revascularization did not significantly reduce the rate of death from any cause or the rate of major cardiovascular events overall. Insulin sensitization and insulin provision also had similar cardiovascular outcomes. In patients with type 2 diabetes and stable ischemic cardiovascular disease, revascularization did not significantly reduce the rate of death from any cause or the rate of major cardiovascular events overall, as compared to medical therapy. Insulin sensitization and insulin provision also had similar cardiovascular outcomes. Patients with type 2 diabetes mellitus have a higher risk of cardiovascular events and death than those without diabetes. 1 – 4 Few large, randomized trials have addressed the question of the optimal treatment for patients with diabetes and angiographically defined stable ischemic heart disease. The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial was designed to test treatment strategies for patients with coronary artery disease and diabetes. Our goal was to address the effects of therapy on the rate of myocardial ischemia, a major cause of death in patients with diabetes, and of insulin resistance, the fundamental mechanism underlying diabetes . . .