Transcript Non Communicable Diseases

Clinical Issues in the Management of
Non Communicable Diseases
Dr Gyaneshwar Rao
Colonial War Memorial
Hospital
Suva
Presentation Outline
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NCD Conditions
Fiji Step Survey 2002
Diabetes and Related Issues
Fiji Dialysis Centre
Hypertension
Coronary Angiographic Services
Non Communicable Diseases
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Diabetes
Hypertension
Ischaemic Heart Disease
Stroke
Rheumatic Heart Disease
Cancers
Distribution of Deaths in Fiji - 2000
Communicable,
maternal and
perinatal
diseases
10%
Injury and
poisoning
8%
Noncommunicable
diseases
82%
Disease Trends in the Pacific
I
N
C
I
D
E
N
C
Communicable
diseases
Non-communicable
diseases
E
Ancient Past
1700s
Present
Fiji Step Survey 2002
Diabetes
-
16%
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Hypertension
-
19
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Weight : Obese -
18
Overweight
28
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Hyperlipidaemia F/M
38/49
Fiji NCD Steps Survey 2002
Inactive
Sample Population
• 6,783 participants
• M 53%; F 47%
• 15 – 64 years
76
Fruit
66
Kava
65
↑ Chol, M
49
Alcohol
45
↑ Chol, F
38
Smoking
37
Overweight
29
Vegetable
26
HTN
19
Obesity
18
Diabetes
16
0
20
40
Percentage
60
80
Screening for Type 2 Diabetes
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Preclinical phase : 10 – 12 yrs
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Tight Control
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: Micro/Macrovascular
Screening (FBS) : Symtomatic
: Asymptomatic
Pre diabetics - studies, long term
Effectiveness of Early Detection and
Treatment of Type 2 Diabetes
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Diabetes – no trial done
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Hypertension - reduces CVD by 50%
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Lipid Control
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Aspirin – reduces CAD
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Other lifestyle factors
Assessing Diabetic Complications
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Microvascular
- Eye
- renal
- neuropathy
Macrovascular
- coronary, PVD
- cerebrovascular
- renovascular
Self Monitoring of blood glucose in type
2 Diabetes
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Established practice
Benefit - on insulin
- oral drugs
Systemic reviews &
Clinical Trials
HbA1c - 0.25%, 0.39%
DiGEM trial – 0.17%
Early Insulin Therapy
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Microvascular
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Macrovascular
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Beta cell function
Diabetes and Macrovascular Disease
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DCCT
(Diabetes Control Complication Trial)
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UKPDS
( United Kingdom Prospective Diabetic
Study)- 25% reduction in microvascular
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ACCORD ( The Action to Control Cardiovascular Risk
in Diabetic Study Group)
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ADVANCE ( The Action in Diabetes and Vascular
Disease: Preterax and Diamicron
Modified ReleaseControlled Evaluation)
Diabetic Nephropathy
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Early Detection
Protein restriction
ACE Inhibitors
Hyperglycaemia
Hypertension
Hyperlipidaemia
Other vascular risk factors
Mild Hypertension
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Cut off level
Period of observation
Indications - diabetics
- chronic kidney disease
- target organ damage
- multiple risk factors
- vascular disease
Choice of drugs
Difficult Hypertension
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Compliance
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Diet
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Secondary cause
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Diuretic
Cerebral Autoregulation
Coronary Artery Disease
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Angiogram – SPH
CABG
Angiogram Suite
Thank You
Health
is
Wealth