Diabetic macroangiopathy is a common complication of diabetes characterized by persistent arteriosclerosis in the macrovascular bed. Several cohort studies have confirmed that intestinal flora and their metab⁃ olites can influence the occurrence and development of diabetes and arteriosclerosis through a variety of metabolic pathways. This paper focuses on the interaction between intestinal flora and diabetic macroangiopathy，analyzes the relationship between intestinal flora，diabetes and vascular lesions，and explores the potential of intestinal flora in the prevention and treatment of diabetic macrovascular complications ，in order to provide new strategies and research targets for the prevention and treatment of complications of type 2 diabetes.