<p>This study assessed the features of the course of acute coronary syndrome in patients with diabetic neuropathy. Additionally, the role of antihyperglycaemic therapy as a cardio protection factor in this syndrome was determined by analysing the available literature data and clinical guidelines. Various antihyperglycaemic drug groups demonstrate possible molecular mechanisms of protection against ischemic cardiomyocytes. Cardiovascular disease treatment for patients with type 2 diabetes mellitus is rapidly developing. However, many aspects, including the exact mechanisms of the cardio protective action of antihyperglycaemic drugs, the presence of an additional positive effect of antihyperglycaemic drugs for patients with other diseases (e.g. kidney disease and chronic heart failure), and possible primary prevention of cardiovascular events in patients with type 2 diabetes, remain unclear.</p><p>Received 11 September 2020. Revised 16 January 2021. Accepted 10 February 2021.</p><p><strong>Funding: </strong>The study did not have sponsorship.</p><p><strong>Conflict of interest: </strong>Authors declare no conflict of interest.</p>