BACKGROUND An increased thickness of the carotid artery wall is thought to be a sign of early atherosclerosis. We have investigated the effect of early treatment with buflomedil on the prevention of the arterial wall thickening. METHODS Eighty patients with Type 2 diabetes were studied. Oral buflomedil (600 mg once daily) was administered for 12 months in 42 patients randomly selected, while 38 received no treatment. The two groups were matched for age, sex, body mass index (BMI), duration of diabetes and glycaemic control. Arterial wall thickness was measured as the mean of the maximum intima media thickness (IMT) in 8 carotid segments measured by B-mode ultrasound. RESULTS Blood pressure and lipid levels remained unchanged in the two studied groups while no difference was found in metabolic control between them. The IMT increase over 12 months was 0.04 mm in the buflomedil group whereas in that without buflomedil it was 0.10 mm. CONCLUSIONS We conclude that buflomedil treatment may be useful in decreasing the progression rate of arterial wall thickness.