Hypoxia-Inducible Factor 1Hypoxia, at least in part through activation of the hypoxiainducible factor 1 (HIF-1) α-related pathways, controls all steps of the postischemic revascularization process. Recent studies uncover that destabilization of HIF-1 is most likely the event that transduces hyperglycemia into the loss of the cellular response to hypoxia in most diabetic complications.2 Levels of HIF-1α are decreased in biopsies from foot ulcers of patients with diabetes mellitus as compared with venous ulcers that share the same hypoxic environment but are not exposed to hyperglycemia.3 Downregulation of HIF-1 in response to hyperglycemia also seems to account for the decreased collateral growth triggered by myocardial ischemia in patients with © 2014 American Heart Association, Inc. Abstract-In patients with diabetes mellitus, the ability of ischemic tissue to synchronize the molecular and cellular events leading to restoration of tissue perfusion in response to the atherosclerotic occlusion of a patent artery is markedly impaired. As a consequence, adverse tissue remodeling and the extent of ischemic injury are intensified, leading to increased morbidity and mortality. Growing evidence from preclinical and clinical studies has implicated alterations in hypoxia-inducible factor 1 levels in the abrogation of proangiogenic pathways, including vascular endothelial growth factor A/phosphoinositide 3′ kinase/AKT/endothelial nitric oxide synthase and in the activation of antiangiogenic signals characterized by accumulation of advanced glycation end products, reactive oxygen species overproduction, and endoplasmic reticulum stress. In addition, the diabetic milieu shows a switch toward proinflammatory antiregenerative pathways. Finally, the mobilization, subsequent recruitment, and the proangiogenic potential of the different subsets of angiogenesis-promoting bone marrow-derived cells are markedly impaired in the diabetic environment. In this review, we will give an overview of the current understanding on the signaling molecules contributing to the diabetes mellitusinduced impairment of postischemic revascularization mainly in the setting of myocardial infarction or critical limb ischemia. (Arterioscler Thromb Vasc Biol. 2014;34:1126-1135.)