risk factor profile and control in type 2 diabetes at knh
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Transcript risk factor profile and control in type 2 diabetes at knh
What does it mean to our patients?
Presenter: CF Otieno
Affiliation: Department of Clinical Medicine and
Therapeutics,UoN & KNH-Medicine
TYPE 2 DIABETES
Progressive disease
Well characterized . . .
But-poorly controlled
Broad treatment goals:-
glycaemia,BP,LDL,Weight,Knowledge,Self
management,HRQoL etc
RISK FACTORS OF COMPLICATIONS
Microvascular
Hyperglycaemia
Genetics
(Hypertension)
Macrovascular
Lipids
Hypertension
Genetics
Age
COMPLICATION PROFILES AT KNH
Microvascular
Eye
Neuropathy
Nephropathy
• Microalbuminuria
• Macroalbuminuria
• ESRD
MACROVASCULAR
COMPLICATIONS
Cerebrovascular disease (Mwazo)
Myocardial infarction (Nguchu)
(STEMI/NSTEMI)
Erectile dysfunction (Ngalyuka)
COMPOSITE COMPLICATIONS
Renal disease
Diabetic foot ulcer, 7.8%:
(Diabetes) – Risk factors
(The patient) – Knowledge, Attitude, Practice
(The health unit) – Policy
Foot-at-risk>33%
(Mugambi E, et al)
RISK FACTOR PROFILE AT KNH
Glycaemic control: <40% good control
BP control – only 50% known HTN, out of these only
25% well controlled.
Lipids - high LDL
Adherence to treatment – POOR
REASONS FOR POOR CONTROL
Provider factors:
Knowledge, Attitude, Practices, etc
System factors
Policies, Medication access, Insulin access
Patient factors
Knowledge, Attitude, Practices, Socio-Economic
Status
Heterogeneous disease
CONSEQUENCES OF POOR
CONTROL
Enhanced complications ( at early age)
Renal
Cardiac
Stroke
Attenuated HRQoL
Health resource consumption-hospitalization;
dependance.
CAN WE STEM THE TIDE?
Access to care:
Policies
Physical
Quality of care and evaluation
Clinical end-points
Administrative end-points
Risk stratification of patients?
Address fatigue of care providers?
AREAS TO ADDRESS
Health system adjustment: patient-focused decision-
making
Generate evidence:-longitudinal studies for outcomes;
RCTs etc.
Cost-related studies-effectiveness and benefit analysis
MORTALITY reviews
In conclusion, . .
We need to ask ourselves:
Can we tell whether our patients are better off NOW
than thirty years ago ?
OR
What ails our patients? What does the care we give
mean to them ?
THANK YOU