Diabetes mellitus is one of the factors causing the cardiovascular risk increase. The myocardium non-coronarogenic lesions including diabetic cardiomyopathy have been discussed for the recent years. Heart failure development is one of the cardiomyopathy manifestations in diabetes adding to a negative prognosis and requiring an optimal antihyperglycemic therapy. The antihyperglycemic drugs use validity is analyzed taking into account the modern data obtained in randomized researches. Data on the recommended additional approaches to be used in the real clinical practice is provided.