It is a hot and sweltering afternoon in Jeddah and more than the odd patient seems to have opted to stay away for this afternoon. So left with a bit of time between the ones who have made it through I thought I would just have a quick read of the UpToDate entry on Diabetes and revise my daily practice. As I read I thought I would post to my blog. First point: Should we screen asymptomatic diabetics for silent heart disease with stress tests?
I never screened asymptomatic diabetics with stress testing but have noted some of my colleagues doing this. UpToDate agrees that there is evidence this will improve outcomes:
“Despite the frequency of silent ischemia, however, it has not been proven that identifying asymptomatic disease or providing early intervention will improve outcomes in this population. In addition, CHD risk factors (dyslipidemia, hypertension, smoking, positive family history of early coronary disease, and presence of micro- or macroalbuminuria)  do not predict the likelihood of having ischemic findings on stress testing or coronary angiography [16,17].
Thus, the American Diabetes Association guidelines recommend annual assessment of risk criteria to identify patients who might benefit from interventions such as aspirin, ACE inhibitors, and statin therapy, but no longer recommend that these criteria be used to identify patients for stress testing .”