BACKGROUND The natural history of diabetic nephropathy is well defined in type 1 diabetes, but to a lesser degree in type 2 diabetes, possibly due to diversity of involved risk-factors. The main aim of the study was to assess modifiable and nonmodifiable risk-factors in the development of persistent proteinuria in patients with type 2 diabetes mellitus. METHODS A random sample of 90 diabetic patients, regularly checked up at the Department of Endocrinology, was selected and followed up in a period of 5 years. There were 46 males and 44 females, aged 51.8 +/- 9.9 years, with average duration of disease of 6.8 +/- 5.2 years, including 58 (64.4%) hypertensive patients and 58 (64.4%) smokers. All the participants had fasting and postprandial glycaemia, Hbalc, 24/hour proteinuria and blood pressure measured. Only 4 (4.4%) persons had 24/h proteinuria > 200 mg/d at the beginning of the study. RESULTS In a 5 year period, 21 (23.3%) patient developed proteinuria of > 200 mg/d. The main prognostic factors were Hbalc values (RR 3.5, p = 0.03), duration of the disease (RR 3.1, p = 0.02), hypertension (RR 2.9, p = 0.02), with stronger impact of diastolic than systolic values (RR 2.01 vs RR 1.83), age (RR 1.35, p = 0.02), glycaemia with stronger correlation of postprandial than fasting values (RR 1.52 vs 1.34), smoking (RR 1.26, p = 0.06) while sex and BMI values were not strongly associated with the development of the proteinuria (RR 1.09 and RR 1.01 respectively). CONCLUSIONS Results indicate that, in addition to glycemic control, control of additional modifiable risk-factors, particularly hypertension and smoking, is of utmost importance in the treatment of patients with type 2 diabetes mellitus.

The objective of this study was to investigate the impact of almost 3 years of war on glycaemic control and blood pressure in Sarajevans with non-insulln-dependent diabetes mellitus (NIDDM). Fifty-five patients with NIDDM were randomly selected from a register of 279. Data from pre-war records were retrieved and the same measurements were repeated using a similar methodology. These included blood glucose levels, ghycosylated haemoglobin Ale (HbAlc), serum cholesterol and triglycerides. Other measurements included weight, height and systolic and diastolic blood pressure. Information was collected on the prescribed therapy, the availability of drugs and access to medical facilities. Weight was significantly reduced by 11.7 ± 8.2 kg. Sixty per cent of the sample were obese (body mass index (BMI) >30) before the war compared with only 18% afterwards. The percentage of patients with NIDDM with acceptable blood glucose values Increased from 15 to 35%. The values of HbA1c improved significantly but no differences in the total serum cholesterol or in the trigiyceride levels were found. Twenty-five of the participants were hypertensive (BP > 140/90 mmHg) before the war compared with only 14 in 1994–1995. The number of patients controlled without any anti-diabetic medication increased from 3 to 13. The reduction in anti-diabetic drugs and blood pressure probably occurred as a result of the significant weight loss. It can be concluded that glycaemic control and the level of hypertension improved in patients with NIDDM in Sarajevo during the war. These findings have major implications for future policies related to public health.

78 diabetics and a healthy control group of 100 were evaluated according to their haemorrheological parameters (whole blood viscosity, plasma viscosity, aggregability and rigidity of erythrocytes). Diabetics were divided according to type of diabetes, quality of metabolic control and expression of microangiopathy. Hyperviscosity was noted in both groups of diabetics as compared to the control group. Changes in patients with IDDM were more pronounced in erythrocyte rigidity, while in patients with NIDDM they were more expressed in cell aggregability. These changes were present even before the clinical onset of the late complications of diabetes, although they were more expressed in patients with complications. Changes in patients with good metabolic control, were less expressed in comparison to those with poor metabolic control. The conclusion is that metabolic derangements in diabetes have an important influence on haemorrheological properties. Thus, reducing blood viscosity in these patients, may be a promising approach to improving microcirculation and delaying the progression of microangiopathy.

Since the invention of insulin and further, the numerous research workers have been trying to get the hormone in the most possible purest form and to make it more convenient for the treatment. By gel-filtration and ion-exchange chromatography can be obtained maximum purified insulin the so-called monocomponent insulin which possesses considerably less antigen characteristics than the conventional insulins. The human insulins obtained by semisynthesis and biosynthesis through genetic engineering the further progress in the treatment of diabetes mellitus by insulin. The intensified insulin therapy is applied nowadays by repeated injections of insulin, through application of insulin pumps in the so-called open systems and by application of artificial pancreas in the so-called closed systems. The complete normalization of glycemia can be achieved only by means of the closed system and that is the system which would work at the principle of glucose-insulin feed back. Unfortunately, these devices are very big and their use for nowadays in everyday practice is not possible yet.