Abstract: Pyroptosis is a form of inflammatory programmed cell death pathway. In vitro and in vivo studies have shown that pyroptosis contributes to the development of macrovascular complications of diabetes, mainly through activating inflammasomes and caspase-1/4/5/11, cleaving gasdermin D (GSDMD), releasing interleukin-18 (IL-18), IL-1β and other inflammatory cytokines. In recent years, the effect of systemic chronic inflammation caused by pyroptosis through inflammatory cascade reaction on macrovascular complications of diabetes has received long-term attention. This article reviews studies of pyroptosis in macrovascular complications of diabetes and the related drugs to provide promising thought for treating macrovascular complications of diabetes in clinical.