diabetes mellitus experiences a rampant growth and is currently affecting more than 150 million people worldwide . the onset of diabetes heralds the beginning of the macrovascular complications of our body . the correlation between diabetes and cardiovascular diseases is still nebulous and is presumed to be related to hyperglycemia , hyperinsulinemia , altered lipid metabolism , hypercoagulability , and inflammation [ 2 , 3 ] . the malefactor behind this is more diffused , deep - rooted , and advanced nature of coronary artery disease in such diabetic individuals . moreover , the anatomy of coronary arteries involves small vessels and long lesions [ 5 , 6 ] . the chances of platelet aggregation and thrombotic events are more in diabetics than in nondiabetic individuals . these pose a challenge against treatment with percutaneous coronary intervention ( pci ) due to more repetitive restenosis , late luminal loss , and stent thrombosis . but much improvements have been seen in medical management by pci , if we compare 1-year mortality rates of bypass angioplasty revascularization investigation ( bari ) with arterial revascularization therapy study ( arts ) [ 2 , 8 , 9 ] . but still there are multiple opinions and dilemmas regarding favorable outcomes of biodegradable polymer coated sirolimus - eluting stents in diabetic population . thus , the main aim of our study is to demonstrate safety and efficacy of biodegradable polymer coated sirolimus - eluting stents in diabetic population . this was a retrospective , single - arm , non - randomized , multicentre registry involving diabetic patients treated with indolimus sirolimus - eluting stents ( sahajanand medical technologies pvt . ltd . ) from june 2012 to may 2014 . written informed consent was obtained from all the patients enrolled in the study or from their legally authorized representative . the study was conducted in accordance with the principle of good clinical practice and declaration of helsinki . patients were included if they were at least 18 years of age , had diabetes mellitus according to world health organization report , and presented with stable or unstable angina or myocardial ischemia or acute or recent myocardial infarction . patients were excluded ( 1 ) if they had known allergy to aspirin , clopidogrel , cobalt - chromium , heparin , ticlopidine , sirolimus , and polymers or ( 2 ) if the patient had impaired glucose tolerance without pharmacologic treatment , transient hyperglycemia , or gestational diabetes . the indolimus biodegradable polymer coated sirolimus - eluting coronary stent involves l605 cobalt chromium ( co - cr ) alloy as its stent platform . the biodegradable polymer gives it a strut thickness of 60  m and drug load of 1.4  g / mm . about 70% of drug is released within 7 days and remaining drug is released over a period of 48 days ( figure 1 ) . the drug is released within 7 weeks after the stent implantation from the polymeric layers coated onto the surface of the stent . the biodegradable polymeric film is a blend of different biodegradable polymers , poly l - lactide , 50/50 poly dl lactide - co - glycolide , and polyvinyl pyrrolidone , which undergoes hydrolysis . this process takes approximately 9 to 12 months after which all the polymers degrade naturally and excrete from body in the form of their metabolites . the average coating thickness of indolimus stent is between 5 and 6  m . the indolimus stent is available in lengths of 8 , 12 , 16 , 20 , 24 , 28 , 32 , 36 , and 40  mm and available diameters were 2.5 , 2.75 , 3.0 , and 3.5  mm . all patients received a loading dose of 300  mg of aspirin and clopidogrel ( 300  mg ) or prasugrel ( 60  mg ) or ticagrelor ( 90  gm ) . the procedural anticoagulation was achieved with either heparin or bivalirudin . however , the intraprocedural administration of glycoprotein iib / iiia - inhibitor was at the investigator 's discretion . all the patients received dual antiplatelet therapy ( aspirin 75300  mg / daily indefinitely and clopidogrel 75  mg / daily or prasugrel 10  mg / daily or ticagrelor 90  mg twice daily for at least 6 months ) after the procedure . the primary endpoint of the study was a conglomeration of cardiac death , myocardial infarction ( mi ) ( q - wave and non - q - wave ) , target lesion revascularization ( tlr ) , target vessel revascularization ( tvr ) , and stent thrombosis ( st ) . the secondary endpoints will be measured at 12 and 24 months and yearly thereafter for five years . q - wave mi was considered , when there was development of new q - wave of more than 0.04 seconds in two or more adjoining leads along with increase in cardiac markers like troponin i or t , creatine kinase , or mb isoform . non - q - wave mi was considered when there was more than three - time elevation in creatinine kinase levels along with elevation in mb isoform and troponin marker t or i without development of new q - waves . target lesion revascularization was considered when there was stenosis in treated segment ( 5  mm proximal and 5  mm distal edges ) . target vessel revascularization was considered when there was stenosis in any segment of the treated vessel . stent thrombosis ( st ) was considered acute when it occurred within 24 hours , subacute when it occurred between 1 and 30 days , and late when it occurred after 30 days . clinical follow - up , by hospital appointment or telephonic conversation , was scheduled at 30 days ( 7-day window period ) , 6 months ( 15-day window period ) , and 9 months ( 30-day window period ) . follow - up data were collected pertaining to current anginal status , intake of antithrombotic regimen , and occurrence of any cardiovascular events or any invasive or noninvasive procedure that the patient had undergone . the average stent length and diameter were 27.1  8.7  mm and 3.1  0.4  mm , respectively . the baseline demographics of all the treated patients are described in table 1 . out of all the diabetics ( mean age = 53.4  10.2 years ) , majority of them were male ( 68.8% ) . lesions type b , type c and totally occluded lesions were found in 317 ( 72.5% ) , 51 ( 11.7% ) , and 45 ( 10.3% ) patients , respectively . the clinical follow - up at 9 months was obtained for 370 ( 99.4% ) patients . at 9-month follow - up , mace was found to be 2.2% which is a composite of 2 ( 0.5% ) cases of myocardial infarction , 4 ( 1.1% ) cases of target lesion revascularization , and 2 ( 0.5% ) cases of stent thrombosis . the clinical outcomes of patients at 30-day , 6-month , and 9-month follow - up are shown in table 3 . the cumulative event - free survival by kaplan meier method was found to be 97.8% at 9-month follow - up ( figure 2 ) . does diabetes mellitus worsens the prognosis and long - term outcomes of patients with coronary artery disease ? this long held question still poses a dilemma and the answer quite fluctuates between fact and fiction . it is long established that diabetes increases the rates of restenosis and repeat revascularization after coronary angioplasty [ 12 , 13 ] . this belief was so severe that in the germinating era of bare metal stents surgery was considered as the primary option for patients with diabetes and multiple - vessel disease . the bypass angioplasty revascularization investigation ( bari ) trial demonstrated the equivalence of angioplasty and bypass surgery but the five - year outcomes of bari trial demonstrated crystal clear advantage of surgery in subset of patients with diabetes . the introduction of drug eluting stents revolutionized the concept of safety and efficacy in diabetic population . the sirius trial demonstrated that at 9 months tlr rate was reduced in diabetic population from 22.3% in bms group to 6.9% in ses group . consistent with this , our study also demonstrated a low tlr rate of only 1.1% at 9-month follow - up . the lower rates of restenosis associated with our stent can be because of lower strut thickness , as stents with lower stent thickness elicit less angiographic and clinical restenosis than stents with thicker struts . theoretically , due to aggressive atherosclerosis , platelet hyperactivity , impaired fibrinolysis , and endothelial function after arterial injury , diabetes mellitus is associated with antiplatelet resistance and consequent stent thrombosis after angioplasty . but , paradoxically , our study presented only two cases of stent thrombosis at 9-month follow - up . this is also supported by the results from isar - diabetes study and diabetes trial [ 18 , 19 ] . reported that one - year event - free survival after stenting is lower in diabetics ( 73.1% ) versus ( 78.8% ) in nondiabetics . the event - free survival at 9 months in our study was found to be 97.8% , which is quite appreciable . contrastingly , there are studies which demonstrate that cumulative event - free survival is not affected by diabetic status . the results of our study are quite promising . however the long - term follow - up of the study would prove maintained safety and efficacy . the use of indolimus in high risk diabetic population is associated with lower incidence of tlr , st , and consequent mace . thus , the long held dilemma about the favorable outcomes after implantation of biodegradable polymer coated sirolimus - eluting coronary stent system in diabetic population turns out to be a fact and not fiction .