Exercise stress testing in patients with type 2 diabetes: When are asymptomatic patients screened?

Abstract

Symptomatic patients benefit from diagnostic cardiac stress testing, whereas patients with known or suspected CAD obtain clinical value of a noninvasive prognostic test primarily through risk stratification into either low- or high-risk groups and interpretation of the results. However, for asymptomatic patients with diabetes, identification of cardiovascular risk factors and risk stratification may assist physicians in justifying the performance of treadmill evaluations. Patients considering exercise at a moderate or vigorous level or those in the highest-risk group can be immediately submitted to exercise stress testing and then referred for further evaluation as indicated. Patients with a normal exercise stress test may be reevaluated every 2 years. Whatever type of patient is being evaluated, the overall goals are the same: to reduce the occurrence of a cardiac event and improve patients' overall quality of life and survival. All patients deserve aggressive risk factor modification (smoking cessation and control of glucose, lipids, and blood pressure). Until evidence-based studies are available, there will be continued controversy regarding the proper CAD screening of asymptomatic patients with diabetes.