The pathophysiologic effects of diabetes on the heart occur, in part, through activation of the sympathetic nervous system. To date, no randomized clinical trial has investigated beta blocker therapy prospectively in a population of patients who have diabetes and HF. The question of the efficacy of beta blockers in patients who have diabetes and HF and the concern over adverse metabolic effects has limited the use of these agents in this patient population. Clinical trial evidence and recent meta-analysis data confirm the efficacy of specific beta blockers in patients who have HF and diabetes. In addition, negative metabolic effects have not been seen with the use of the nonselective agent carvedilol. Therefore, in the absence of contraindications, beta blockade should not be withheld in treating patients who have diabetes and HF; and their use may be instrumental in preventing further progression of HF and death in this population.