• Diabetes melitus is a major risk factor for morbidity and mortality through premature and accelerated atherosclerosis;

• Coronary and cerebrovascular disease is 2-4 times as common in a diabetic and the post-infarction mortality is higher; clinical assessment of coronary artery disease may be difficult due to the high incidence of asymptomatic cardiac ischemia in diabetics;

• Peripheral vascular disease is 4-6 times more commons in a diabetic associated presence of neuropathy accentuates diabetic foot problems.

• The prevalence of these complications is increased manifold in the diabetic population and tends to occur in a more severe form, and at a relatively younger age.

• The usual relative protection against atherosclerosis prior to menopause is lost in diabetic women.

a) obesity, especially central obesity.

b) hypertension .

c) sedentary lifestyle.

d) LDL-C levels above 100 mg%.

e) HDL-C levels below 45%.

f) Serum triglycerides above 150 mg%.

g) Microalbuminuria, in those who are dipstick negative.

h) Use of tobacco in any form..

i) Family history of premature coronary artery disease (leading to death before 55 years of age.)

1) a comprehensive clinical history and examination for the presence of coronary heart disease, or cerebrovascular, or peripheral vascular disease; this includes questions about previous angina. TIAs, intermittent claudication, established myocardial infarction etc.

2) family history for premature coronary artery disease.

3) A complete physical examination for cardiac function, presence or absence of peripheral pulses, presence of bruits, evidence of peripheral and / or cerebral ischemia.

4) Blood pressure recordings.

5) Height and weight (BMI) and waist-hip ratio

6) Lipid profile this profile should include, estimation of serum triglycerides, serum total cholesterol, HDL-cholesterol and calculated LDL cholesterol although preferable to do in a fasting state, may be done with a random sample, and the values confirmed in the fasting stage, if abnormal.

7) Estimation for the presence of microalbuminuria in those who are dipstick (albustix) negative;

8) History of tobacco use.

9) Standard resting 12 lead ECG; sensitivity of the standard 12 lead resting ECG is moderate and cannot rule out the possibility of clinically significant disease.

Further investigation would depend on individual circumstances and degree of clinical suspicion.

Most of these investigations are a part of the routine work up of all diabetic patients.