Diabetic autonomic neuropathy (DAN) is an individual risk factor for nonfatal myocardial infarction, nonfatal stroke, cardiovascular death, other major cardiovascular events like hospitalization for angina, hospitalization for heart failure, urgent revascularization for unstable angina, and death from any cause. Diabetic autonomic neuropathy screening is of paramount importance for cardiovascular risk stratification in patients with and without cardiovascular disease; as a marker for patients requiring more intensive monitoring during the perioperative period and other physiological stresses; and as an indicator for more intensive pharmacotherapeutic and lifestyle management of comorbid conditions. The present review highlights the necessity of DAN screening in starting cardiovascular outcome trials for antidiabetic agents.