Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: The DIAD study: a randomized controlled trial 

The utility of screening diabetes patients for asymptomatic ischemia with myocardial perfusion imaging is controversial.  The DIAD study is the first randomized trail that evaluated this important clinical question.  In total 1123 asymptomatic type 2 diabetes patients were randomized between screening with adenosine-stress MPI and no screening.  Patients were followed thereafter for 4.8 years.  The most important results are the following

1. In the screened group patients with moderate or large MPI defects had higher events rates as compared to patients with small MPI defects or a normal MPI study.  However, only 17% of the screened patients had MPI defects and the positive predictive value of having moderate or large MPI defects was only 12%
2. Cardiac event rates during follow-up were low (0.6%/year) in both groups and were not significantly reduced by MPI screening.
3. During the course of the study there was a significant and equivalent increase in primary medical prevention in both groups.

Therefore, the results of the DIAD trial do not support routine screening for myocardial ischemia with MPI in asymptomatic type 2 diabetes patients.

1. Young L, Wackers F, Chyun D et al.  Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: The DIAD study: a randomized controlled trial. JAMA 2009;301:1547-1555.