BACKGROUND Continuous glucose monitoring systems can monitor moment-to-moment changes in blood glucose concentration, which cannot be detected by intermittent self-monitoring. Continuing monitoring systems may lead to improved glycemic control. We evaluated a microdialysis technique for improving glycemic control in type 1 diabetes patients treated by different means of basal insulin substitution. PATIENTS AND METHODS Fifty-two type 1 diabetic patients on twice daily NPH and pre-meal aspart insulin were randomized in two groups: the continuation of NPH (n=26) (group 1) or once daily glargine (n=26) (group 2). 48-hour GlucoDay registrations were started at the beginning and after 4 months. RESULTS At baseline, time spent in the euglycemic range (glucose between 3.9 and 8.0 mmol/L) was 37.96±6.81% for the NPH group and 35.83±6.24% for the glargine group. At endpoint, time in the euglycemic range increased in both groups (51.02±7.22% and 57.29±10.27%, P<0.001 vs. before treatment for both groups). Time spent in the hypoglycemic range (glucose <3.9 mmol/L) was 9.98±2.57% for the first group and 10.24±3.55% for the second group at baseline. At endpoint, time in the hypoglycemic range decreased in both groups (8.00±2.13% and 6.59±2.04%, P<0.001 vs. before treatment for both groups). CONCLUSION The analysis of the GlucoDay data gave us information about glycemia other than HbA1c and self-monitoring of blood glucose, such us a peakless activity profile and the lower percentage of time spent in the hypoglycemic range in the glargine-treated group.

BACKGROUND Diabetics have a 3-fold risk for cardiovascular diseases compared with non-diabetics. This study was designed to evaluate cerebral hemodynamic changes related to type 2 diabetes mellitus (DM) with transcranial Doppler ultrasonography (TCD). TCD is a highly sensitive and specific method of quick bedside assessment of cerebrovascular circulation hemodynamics. PATIENTS AND METHODS In a prospective study, we compared a group of 100 patients with the diagnosis of type 2 diabetes mellitus (aged 48 to 67 years) and an age- and sex-matched control group of 100 healthy subjects without diabetes mellitus. We measured flow velocities (Vm) and the Gosling pulsatility index (PI) of the middle cerebral artery (MCA). RESULTS The rate of TCD abnormalities was significantly higher in diabetic patients than in healthy control subjects (55% vs. 11%, P<0.05). The PI was significantly higher in diabetic patients than in healthy controls (P<0.001). Atherosclerotic changes were found in 34.0% and 71.4% of patients suffering from diabetes for <5 and ≥5 years, respectively. CONCLUSION This study suggests that TCD is a useful marker for the detection of diabetic cerebrovascular changes. The duration and type of diabetes were found to have an impact on the development of pathologic cerebrovascular changes.

From Clinical Hospital Split, *Department of Gastroenterology and Hepatology, †Department of Nephrology, ‡Department of Pathology, §Department of Microbiology, Split, CroatiaCorrespondence:Prof. Izet Hozo MD, PhDDepartment of Internal Medicine,Clinical Hospital Split, Soltanska 1, Split, CroatiaTel: 385-21-55-76-58Fax: 385-21-55-76-58Izet.Hozo@st.htnet.hrAccepted for publicationNovember 2004