Cardiovascular disease is the leading cause of death in patients with diabetes therefore prompt diagnosis and treatment of high risk groups is essential. Dobutamine stress echocardiography is a safe, cheap and reliable method for coronary artery disease diagnosis and provides important long term prognostic information. The diagnostic accuracy and prognostic power of this technique has been validated by a number of studies on patients with and without diabetes. This article discusses the application, interpretation, and accuracy of stress echocardiography both in the general population and in patients with diabetes. The role of advanced imaging modalites such as myocardial contrast agents and tissue Doppler imaging is also explored.