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Background: The study was designed to assess the prevalence of silent myocardial ischemia (SMI) in asymptomatic patients of type 2 diabetes mellitus (T2DM) with and without microalbuminuria, by the exercise electrocardiography and to assess the role of microalbuminuria as a marker for detecting silent coronary artery disease (CAD) and role of other conventional CAD risk factors in diabetic patients in development of SMI. Methods: A total of 60 patients with type 2 diabetes mellitus who were dipstick negative for macroalbuminuria and had no history suggestive of CAD or ECG abnormality were taken. Out of 60 patients 30 patients were positive for microalbuminuria by Micral Test® II sticks and 30 were tested negative for microalbuminuria. Subsequently, they were divided into case and control groups. Results: The risk of undetected CAD was increased in male Type 2 diabetics (p <0.05) and in the presence of Microalbuminuria (p <0.05). A positive correlation was found between exercise time and amount of work performed during treadmill test (TMT). A positive TMT with angiographically proven significant coronary stenosis is higher in male and in patients having microalbuminuria. Conclusions: Patients with T2DM and microalbuminuria have significant association with SMI as proven by TMT and coronary angiography. Patient have SMI with severe disease might benefit from revascularization. Patients with less severe disesase may benefit from drug and lifestyle interventions.