P273 Chlamydia antibody titres in type 2 diabetic patients with and without macrovascular disease

S108

Abstracts

/ European

Journal

of Internal

F-87% M), Alcohol 17% (9% F-91% M), Old Stroke 39%, Progress (stagnation 3%. improvement 79% and death 18%). Cross comparison between D.M. and some factors, as Sex, B.P., Smoke, Alcohol, Progress, Old Stroke and TG given the effects: a) D.M. and Sex (M.D.+F 24%, D.M.+M 20%. p=O.867), b) D.M. and Smoke (M.D.+smoke 8%. p=O.82), c) M.D. and Alcohol (M.D.+Alcohol 5%, p=O.45), d) D.M. and Progress (D.M. +stagnation l%, D.M. +improved 35%, D.M. +death 8%, p=O.97), e) D.M. and TG (D.M. yes+TG 142285, D.M. no+TG 124565, p=O.O15), f) D.M. and Old Stroke (D.M.+Old stroke 23%, p=O.O51), g) D.M. and B.P. (D.M.+B.P 34%. p=O.O24). Statistical analysis was performed using a SPSS 11 .O. Conclusion: The study shows that a) The females patients with latter thromboembolic stroke and D.M. versus males are dominant b) The males patients compared to the females are more smoked and drinkers and c) The patients with D.M. and latter stroke had the triglycerides increase, and a history BP and Old Stroke are dominant, statistically significant.

P272 Audit

of secondary

prevention

measures

in patients

with

diabetes

and

stroke

VS. Kumar, K. Mortimer, Ashfield, UK)

K.M.

Seneviratne,

G.A.

Thomson

(Sutton

in

Introduction: Following stroke diabetic patients have a high risk of further vascular events, thus aggressive risk reduction should be initiated. Method: All patients attending the diabetes centre with previous stroke were audited in 2000 using UK national clinical guidelines for stroke. It was repeated in 2002 after implementation of certain recommendations. Discussion: We have identified several areas for improvement; neither blood pressure nor HbAlc targets were reached even after advice, and cholesterol was not measured routinely. Multiple risk factor modification in a diabetic clinic is difficult when it is possible to see many patients at most annually, and stroke is often treated by other specialists. Following the 2000 audit, strategies implemented included medication initiation from clinic, coherent advice to family doctors and patients, and practice nurse follow-up. The impact of these policies is disappointing. We propose to give all diabetic patients a card highlighting the importance of risk factor management, plus a biannual cholesterol checkup. Family doctors will receive clear recommendations detailing target values and management protocols. The recent National Service Framework for Diabetes details minimum standards of care acceptable in the UK. Implementation of more aggressive risk factor management in primary care, a key goal of the NSF, should signiticantly improve the present outcomes.

I(H)

All values in percentage

875

812

SO.8

43.4

61 I

80

96.6

95 I

6X .l

66 6

IT9 7:i/8?.61

,4X25,7946

838

x 67

Medicine

14 (2003)

Sl -S159

P273 Chlamydia antibody titres in type 2 diabetic without macrovascular disease H.U. Rehman, D. Hepburn, C. Walton (Essex, Hull,

patients

with

and

UK)

Objective: The aims of this study are to determine C-pneumoniae antibody titres in patients with type 2 diabetes with macrovascular disease compared to an age/sex match control population with type 2 diabetes free of these complications. Design: A population based case-control study. Participants: 56 male type 2 diabetic patients with no history of ischaemic heart disease (angina or myocardial infarction), symptomatic or proven peripheral vascular disease, or cerebrovascular disease (TIA, stroke or multi-infarct dementia) and 56 male type 2 diabetic patients with history of ischaemic heart disease (symptomatic angina, myocardial infarction), peripheral vascular disease (symptomatic or proven angiographically or via doppler studies), or cerebrovascular disease (radiologically proven ischaemic stroke) selected through the diabetic register. Methods: C pneumoniae antibody titres were measured in 56, male type 2 diabetic patients with no history of ischaemic heart disease (angina or myocardial infarction), symptomatic or proven peripheral vascular disease, or cerebrovascular disease (TIA, stroke or multi-infarct dementia) and in 56, male type 2 diabetic patients with history of ischaemic heart disease (symptomatic angina, myocardial infarction), peripheral vascular disease (symptomatic or proven angiographically or via doppler studies), or cerebrovascular disease (radiologically proven ischaemic stroke) selected through the diabetic register. Urea, creatinine, fasting lipid profile, HbAlc, albumin/creatinine ratio on three different occasions and urinalysis for albumin were measured in all patients. Baseline blood pressure and weights were recorded in all patients. All the patients were age and duration matched and a baseline ECG was recorded in all patients. Analysis: Data was analysed by SPSS for windows by non-parametric statistics. Results: We did not find any association between antibodies for C. pneumoniae and macrovascular disease in type 2 diabetic subjects.

P214 Na/Li-countertransport in patients with diabetic nephropathy S. Gmska. D. Vogelgesang, H. VBlzke, R. Rettig, G. Kraatz (Greifswald, D) Objective: The pathogenesis of diabetic nephropathy is poorly understood. In diabetic patients raised levels of sodium-lithium countertransport (Na/Li CT) seem to be implicated in the pathogenesis of end-organ damage. The present study was designed to test the hypothesis that increased urinary albumin excretion is associated with enhanced sodiumlithium countertransport (Na/Li CT) in typ 2 and typ 1 diabetes mellitus. The influence of known risk factors for albuminuria in diabetes, including age, gender, BMI, HbAlc, systolic and diastolic blood pressure as well as serum HDL and LDL cholesterol levels was tested. Patients and methods: The activity of Na/Li CT was measured in 520 patients with type 2 and in 118 patients with typ 1 diabetes mellitus. The patients in each group were classified into subgroups with normal renal function (albuminary excretion rate AERs 30 mg/24 h) and with diabetic nephropathy (AER>30 mg/24 h). NalLi CT was determined in Liloaded erythrocytes as the difference between the sodium-stimulated and the passive lithium efflux. Results: In typ 2 diabetic patients the Na/Li CT did not show a significant difference between normoalbuminuric (257+106 pmol/lXh) and patients with nephropathy (264592 p.mol/lX h). Similarly, there was no significant difference between typ 1 diabetic patients with normal renal function (2465107 pmol/lXh) and patients with elevated AER (279? 122 pmol/lXh). Age, gender, mean arterial pressure and HbAlc were independent predictors of albuminuria in typ 2