International Circulation:  What issues then do we need to confront in the application of drug-eluting stents in diabetics?

David Holmes: In diabetics we have the issue as it relates to what metric we evaluate.  For re-stenosis in diabetics， clearly drug-eluting stents are better than bare metal stents.  The question is any revascularization better in diabetic patients remains unclear and unsettled from the BARI 2D study， which is a different topic.  We know that in diabetic patients we know， firstly， that we need to treat ischemia.  Secondly that we need to select， depending on the severity of disease and the extent and severity of ischemia， which revascularization strategy is most appropriate.  If it is going to be a PCI revascularization I believe drug-eluting stents are at the foundation of that but underneath both surgical and interventional revascularization is the urgent need to make sure we optimize optimal medical therapy.