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August 19, 2009

Screening for Asymptomatic Coronary Artery Disease in Patients With Type 2 Diabetes

JAMA. 2009;302(7):735-737. doi:10.1001/jama.2009.1187

To the Editor: Dr Young and colleagues1 reported the results of the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study. This trial addressed whether routine screening of patients with asymptomatic type 2 diabetes for coronary artery disease (CAD) with myocardial perfusion imaging (MPI) is warranted. Among 1123 patients, the primary outcome of cardiac death or nonfatal myocardial infarction occurred in 15 patients in the screening group and in 17 patients in the no-screening group during the mean follow-up of 4.8 years (P = .73). The low-risk nature of the study population is one possible explanation for the negative results of the DIAD study, which had a low rate of high-risk MPI results and low cardiac event rates. However, in a clinical practice setting the presence of advanced CAD in asymptomatic diabetic patients is common, and the prognosis of patients with type 2 diabetes is poor.2

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