1. Exercise Stress Testing for Patients with Diabetes  Based on recommendations by ADA, Native American Cardiology Program, American College of Sports Medicine, Ty Reidhead, M.D., IHS Senior Clinician, Internal Medicine  Exercise Stress Testing should be done before initiating an exercise program that exceeds the demands of activities of daily living (> brisk walking)

2. General Recommendations for Exercise Stress Testing  Age > 35  Age < 25 AND –DM Type 2 of more than 10 years duration OR –DM Type 1 of more than 15 years duration  Presence of any additional risk factors for CHD regardless  Presence of microvascular disease  Presence of peripheral arterial disease  Autonomic neuropathy  Cardiac symptoms, abnormal EKG (with or without sxs)

3. AGELength of DiseaseAdditional CHD Risk/Factors/Other Exercise Stress Test < 25 < 10 years(+)- HTN, tobacco use, hyperlipidemia, chronic renal disease, retinopathy, etc. None Provider discretion < 25 > 10 years(+) - HTN, tobacco use, hyperlipidemia, chronic renal disease, retinopathy, etc. None RECOMMENDED Provider Discretion 25 - 35 < 10 years(+) - HTN, tobacco use, hyperlipidemia, chronic renal disease, retinopathy, etc. None RECOMMENDED Provider discretion > 10 years(+) - HTN, tobacco use, hyperlipidemia, chronic renal disease, retinopathy, etc. None RECOMMENDED > 35 ANY(+) - HTN, tobacco use, hyperlipidemia, chronic renal disease, retinopathy, etc. None RECOMMENDED ANY Cardiac symptoms EKG abnormalities with or without sxsRECOMMENDED