Background <p>Cardiovascular diseases (CVD) are the primary causes of mortality in diabetic patients. Recent advances have demonstrated that stress echocardiography can assist in identifying early cardiovascular changes before the onset of symptoms.</p> Aim <p>This research aims to identify early biomarkers of CVD utilizing stress echocardiography.</p> Methods <p>Thirty patients diagnosed with type 2 diabetes mellitus were included in this study. All individuals exhibited no symptoms related to the cardiovascular system and maintained a preserved left ventricle (LV) ejection fraction. Initially, physical examinations, electrocardiogram, and routine echocardiography were conducted for patients. Subsequently, patients underwent evaluation via stress echocardiography following the administration of dobutamine.</p> Results <p>A significant relationship was observed between FBS levels and alterations in LV GLS at the peak of the stress echocardiography test. Nonetheless, no association was identified among the demographic information of the patients, such as gender, age, and BMI. There was no significant association between HbA1c, the duration of diabetes, and insulin consumption with the LV GLS index.</p> Conclusion <p>A significant relationship exists between FBS levels and LV GLS. This finding highlights the usefulness of dobutamine stress echocardiography in identifying early cardiovascular changes before the onset of symptoms in diabetic patients with CVD.</p> Key messages <p>•&#xa0;Cardiovascular pathology in diabetes begins before symptoms presentation.</p> <p>•&#xa0;Poor glycemic control is associated with alterations in LV GLS.</p> <p>•&#xa0;Prevention of cardiovascular diseases should begin earlier than symptomatic disease.</p> Graphical abstract <p></p>