Improved Outcome
Finally, the screening algorithm should result in the alteration of individual treatment strategies and lead to improved outcome. Although data from the general population suggest that revascularisation or antiischaemic therapy should also be attractive in asymptomatic patients with diabetes, hard evidence is currently lacking. Preliminary data in small patient populations, however, are promising. Sorajja and colleagues observed in 261 asymptomatic diabetic patients with high-risk SPECT studies that revascularisation was independently associated with improved survival.¹¹ Larger prospective studies are currently in progress and their observations are eagerly awaited.

Summary
A growing need exists to establish a clinical strategy for the cardiac evaluation and management of asymptomatic patients with diabetes. Although results from individual studies show a wide variation in exact numbers, the currently available data do suggest a significant prevalence of undiagnosed CAD in this population, which may warrant screening. To this purpose, sequential imaging of atherosclerosis and ischaemia could be a promising strategy. However, both safety and cost-effectiveness remain to be further evaluated. Whether screening and early detection of disease ultimately result in improved outcome has not yet been established.