The American Diabetes Association (ADA) has identified certain risk factors that may indicate that a patient with diabetes who is asymptomatic for cardiac disease may have underlying cardiovascular disease.

Criteria for increased risk:

(1) age > 35 years

(2) type 2 diabetes and duration of disease > 10 years

(3) type 1 diabetes and duration of disease > 15 years

(4) presence of additional risk factors for coronary artery disease (family history, cigarette smoking, hypertension, hypercholesterolemia)

(5) presence of microvascular disease (retinopathy, nephropathy, proteinuria)

(6) presence of peripheral vascular disease

(7) autonomic neuropathy


A patient with one or more risk factors should have a medical evaluation with or without exercise testing prior to undertaking a moderate to strenuous exercise program.

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