Armstrong MJ, et al. - In this cohort study, patients with diabetes who attended an exercise program intake session between 2007 and 2012 were examined to assess is screening with pre-exercise stress testing in patients with diabetes is useful. Using an algorithm requiring sedentary patients with diabetes and ≥ 1 cardiac risk factor to undergo testing, they determined referral for pre-exercise stress testing. They assessed outcomes including cardiac catheterization, revascularization, cardiovascular-related admissions, mortality, and change in care. Referral for pre-exercise stress testing was made for 676 (40%) of 1,705 people with diabetes. They found low rates of cardiovascular outcomes in both tested and untested patients. Over the follow-up periods, they found no difference in adverse cardiovascular outcomes among patients who underwent stress testing. For most patients, there was no impact of referral for stress testing on care. For most asymptomatic patients with diabetes, stress testing is not required before beginning an exercise program.