Diabetes cardiomyopathy (DCM) is a cardiovascular disease with structural damage and dysfunction of myocardium under the condition of glucose and lipid metabolism disorder in diabetes. The main pathological characteristics are ventricular hypertrophy, myocardial remodeling and cardiomyocyte death, which induce heart failure. DCM has become one of the main causes of death in patients with diabetes. As a pro-inflammatory programmed cell death pathway, pyroptosis mediated by inflammasomes is considered an important driver of chronic inflammation due to its excessive activation. Recently, it was found that the over activation of pyroptosis promoted the course of DCM and became the hub connecting the disorder of glucose and lipid metabolism in diabetes and myocardial injury. With the discovery of more and more roles of Traditional Chinese Medicine (TCM) in regulating pyroptosis, TCM affects the occurrence and development of DCM by regulating pyroptosis or protein expression, which has become a research hotspot of myocardial protection strategies in diabetes. This article reviews the mechanism of pyroptosis in DCM and the research progress of TCM monomers and compound prescriptions in regulating the process of pyroptosis in DCM, in order to provide new ideas and targets for clinical research and treatment of DCM.