Cardiovascular disease is the main cause of death for diabetics, and in many cases its presence is silent due to cardiac autonomic neuropathy. Thus, early diagnosis of coronary disease is essential, permitting proper risk stratification and appropriate therapy. This paper examines the usefulness of several noninvasive imaging techniques to study cardiovascular diseases in individuals with diabetes mellitus, with emphasis on nuclear cardiology, and proposes a diagnostic algorithm for detection of silent ischemia.