There is inadequate information about how well cardiologists manage overt or latent diabetes. We reviewed charts of patients who died in an academic outpatient cardiology practice in the period from January 1995 to December 1997 in order to determine the prevalence of hyperglycemia and diabetes, as well as whether their management had been according to the established guidelines. We found that of 128 decedents (mean age 78 years), 22 had had recognized diabetes and 27 undiagnosed hyperglycemia. Evaluation and management of glycemia in either group had not adhered to guidelines, despite the presence of concomitant cardiovascular disease. This was true for assessment of long-term glycemic control or end organ damage, prescription of proper diet, and/or management of other cardiovascular complications. These findings indicate the need for more involvement by cardiologists in the care of patients with overt or latent diabetes beyond the steps taken against their established cardiovascular disease.