Diabetes is a major cause of chronic kidney disease worldwide. Managing CKD in diabetic patients is complex due to accumulation of comorbid conditions such as hypertension, cerebrovascular and peripheral artery disease, as well as increased risk of infection and malnutrition. Reaching end-stage kidney disease, many diabetic patients will choose peritoneal dialysis. This review explores the epidemiology, outcomes, and specific management challenges of diabetic patients undergoing peritoneal dialysis. Literature from PubMed and MEDLINE from 2000 through 2023 was methodically reviewed. In a patient population with increased cardiovascular risk and unique metabolic challenges, the need for individualized treatment strategies in order to improve clinical outcomes is underscored.