In the population with diabetes mellitus (DM), the relationship between vascular disease and the outcomes of individuals with acute myocardial infarction (AMI) has not been established. In the National Inpatient Sample database, all patients with DM who presented with AMI between October 2015 and December 2018 were stratified by the number and location of extracardiac vascular comorbidities (cerebrovascular [CVD], renovascular, neural, retinal, and peripheral [PAD] diseases). The adjusted odds ratios (aORs) of operations and poor outcomes occurring while a patient was hospitalized were calculated using multivariable logistic regression. 366,165 patients with diabetes mellitus (DM) who were hospitalized for an AMI had more than or equal to 1 extracardiac vascular comorbidities (32.8%). Patients with the vascular disease had higher odds ratios (aORs) for mortality (aOR 1.05, 95% CI 1.04 to 1.07), major adverse cardiovascular and cerebrovascular events (MACCEs) (aOR 1.19, 95% CI 1.18 to 1.21), stroke (aOR 1.72, 95% CI 1.68 to 1.76). Major bleeding (aOR 1.11, 95% CI 1.09 to 1.13), as well as lower odds of receiving coronary angiography (CA). Patients with CVD exhibited higher odds of MACCEs, stroke, and significant bleeding. In contrast, those with PAD had higher odds of mortality (aOR 1.29, 95% CI 1.27 to 1.32). (aOR 1.82, 95% CI 1.78 to 1.87, aOR 4.25, 95% CI 4.10 to 4.40, and aOR 1.51, 95% CI 1.45 to 1.57, respectively). Patients with DM who presented with AMI and concurrent extracardiac vascular disease were less likely to have CA or PCI and more likely to experience clinical outcomes. Patients with PAD had a higher risk of dying, but those with CVD had a higher risk of significant bleeding, stroke, and MACCEs.