Article Summary Detection of Silent Myocardial Ischemia in Asymptomatic Diabetic Subjects. Wackers FJ, Young LH, Inzucchi SE, Chyun DA, Davey JA, Barrett EJ, Taillefer R, Wittlin SD, Heller GV, Filipchuk N, Engel S, Ratner RE, Iskandrian AE for the Detection of Ischemia in Asymptomatic Diabetes (DIAD) Investigators. Diabetes Care. 2004;27:1954-1961. Objective: This investigation was designed to determine the prevalence and severity of inducible myocardial ischemia in patients with type 2 diabetes who were previously asymptomatic, and to assess the effectiveness of American Diabetes Association guidelines for identifying silent ischemia in this patient population. Methods: Patients were recruited at 14 primary care outpatient practices in the US and Canada. Criteria for inclusion were (1) type 2 diabetes with onset at approximately 30 years of age and no history of ketoacidosis, and (2) age 50 to 75 years. Patients were excluded if they had a history of angina pectoris, stress test, or coronary angiography during the 3 previous years, or a history of myocardial infarction (MI), heart failure, or coronary revascularization. All patients were under reasonable metabolic control. Results: Fifty percent of patients (561/1123) were randomized to adenosine stress perfusion imaging and follow-up; 50% (562/1123) were randomized to follow-up alone. ECG-gated adenosine technetium-99m sestamibi SPECT imaging was performed in those randomized to stress-perfusion imaging. Twenty-two percent of patients showed evidence of silent myocardial ischemia. Conclusion: Results of this study suggest that perhaps 20% of patients with type 2 diabetes have some level of silent myocardial ischemia and may be at risk for more severe coronary artery disease.