Armstrong MJ, et al. – In this study, investigators assessed the clinical utility of pre-exercise stress screening among individuals with diabetes. Study participants included individuals with diabetes who attended an exercise program intake session between 2007 and 2012. Using an algorithm requiring sedentary patients with diabetes and > 1 cardiac risk factor to undergo testing, they assessed referral for pre-exercise stress testing. Rates of cardiac catheterization, revascularization, cardiovascular-related admissions, mortality, and change in care were also evaluated. They documented low rates of cardiovascular outcomes in both tested and untested patients. Follow-ups in patients undergoing stress testing revealed no variation in adverse cardiovascular outcomes. For most patients, no change in care was brought about by referral for stress testing. For most asymptomatic patients with diabetes, stress testing before beginning an exercise program is not essential.