Drug-coated balloons and diabetes: a review.

Diabetes mellitus (DM) is a major contributor to coronary artery disease (CAD) worldwide. Moreover, DM is associated with more extensive atherosclerotic disease, often with multivessel involvement and complex and vulnerable plaque characteristics, as well as an enhanced thrombotic and inflammatory environment. Altogether, these factors increase the risk of adverse events following percutaneous coronary intervention (PCI) compared to individuals with normal glucose levels. Despite latest generation drug-eluting stents provide better overall clinical outcomes compared with earlier generations, diabetic patients still experience short- and long-term stent-related complications, such as target-lesion revascularization, in-stent restenosis, and stent thrombosis. The development of drug-coated balloons (DCB) has provided a promising alternative in this setting. This innovative technology relies on the delivery of an antiproliferative agent directly to the target lesion without leaving any permanent metallic scaffold. However, the benefit of DCB-based revascularization for CAD patients with DM compared to other techniques as well as the effectiveness of preoperative and postoperative management in improving outcomes have not been fully addressed. This review aims to discuss the impact of DM pathophysiology on the outcomes of PCI and the potential mechanistic benefit of DCB angioplasty in diabetic patients with CAD. Finally, we summarize the results from all current evidence comparing DCB-based to other PCI techniques and propose an individualized approach for treating diabetic patients with CAD.