Diabetes mellitus has become increasingly prevalent in recent years, the most dramatic increase being observed in younger women. Diabetes is a multiplier of cardiovascular risk and decreases life expectancy more in women than in men. Diabetic women are less likely to achieve therapeutic targets for cardiovascular risk factors and to be optimally treated. They present more often with atypical symptoms that cause delays in timely recognition and management of cardiovascular disease. Diabetes is an independent risk factor for heart failure and is associated with a worse outcome in women than in men affected by heart failure. Despite the high prevalence of early asymptomatic ventricular dysfunction in diabetics observed in the DYDA and SHORTWAVE studies, female gender was neither a protective nor predisposing factor to ventricular dysfunction or heart failure. Among 1129 outpatients with heart failure, data from the Cardiovascular Epidemiologic Observatory of Trieste show a prevalence of diabetes of 39% in men and 28% in women. In this ongoing epidemiological study, a significantly better prognosis was observed in female than in male diabetics, whereas diabetic and non-diabetic women showed comparable mortality and hospital admission rates. These findings underscore the impact and effectiveness of strict follow-up and management in the high-risk female diabetic population.