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Clinical Issues in the Management of Non Communicable Diseases. Dr Gyaneshwar Rao Colonial War Memorial Hospital Suva. Presentation Outline. NCD Conditions Fiji Step Survey 2002 Diabetes and Related Issues Fiji Dialysis Centre Hypertension Coronary Angiographic Services.

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clinical issues in the management of non communicable diseases
Clinical Issues in the Management of Non Communicable Diseases

Dr Gyaneshwar Rao

Colonial War Memorial

Hospital

Suva

presentation outline
Presentation Outline
  • NCD Conditions
  • Fiji Step Survey 2002
  • Diabetes and Related Issues
  • Fiji Dialysis Centre
  • Hypertension
  • Coronary Angiographic Services
non communicable diseases
Non Communicable Diseases
  • Diabetes
  • Hypertension
  • Ischaemic Heart Disease
  • Stroke
  • Rheumatic Heart Disease
  • Cancers
slide5

Disease Trends in the Pacific

I

N

C

I

D

E

N

C

E

Communicable diseases

Non-communicable diseases

Ancient Past 1700s Present

fiji step survey 2002
Fiji Step Survey 2002

Diabetes - 16%

  • Hypertension - 19
  • Weight : Obese - 18

Overweight - 28

  • Hyperlipidaemia F/M 38/49
fiji ncd steps survey 2002
Fiji NCD Steps Survey 2002
  • Sample Population
  • 6,783 participants
  • M 53%; F 47%
  • 15 – 64 years

Percentage

screening for type 2 diabetes
Screening for Type 2 Diabetes
  • Preclinical phase : 10 – 12 yrs
  • Tight Control : Micro/Macrovascular
  • Screening (FBS) : Symtomatic

: Asymptomatic

  • Pre diabetics - studies, long term
effectiveness of early detection and treatment of type 2 diabetes
Effectiveness of Early Detection and Treatment of Type 2 Diabetes
  • Diabetes – no trial done
  • Hypertension - reduces CVD by 50%
  • Lipid Control
  • Aspirin – reduces CAD
  • Other lifestyle factors
assessing diabetic complications
Microvascular

- Eye

- renal

- neuropathy

Macrovascular

- coronary, PVD

- cerebrovascular

- renovascular

Assessing Diabetic Complications
self monitoring of blood glucose in type 2 diabetes
Self Monitoring of blood glucose in type 2 Diabetes
  • Established practice
  • Benefit - on insulin

- oral drugs

  • Systemic reviews &

Clinical Trials

HbA1c - 0.25%, 0.39%

DiGEM trial – 0.17%

slide12

Early Insulin Therapy

  • Microvascular
  • Macrovascular
  • Beta cell function
diabetes and macrovascular disease
Diabetes and Macrovascular Disease
  • DCCT (Diabetes Control Complication Trial)
  • UKPDS ( United Kingdom Prospective Diabetic

Study)- 25% reduction in microvascular

  • ACCORD ( The Action to Control Cardiovascular Risk

in Diabetic Study Group)

  • ADVANCE ( The Action in Diabetes and Vascular

Disease: Preterax and Diamicron

Modified ReleaseControlled Evaluation)

diabetic nephropathy
Diabetic Nephropathy
  • Early Detection
  • Protein restriction
  • ACE Inhibitors
  • Hyperglycaemia
  • Hypertension
  • Hyperlipidaemia
  • Other vascular risk factors
mild hypertension
Mild Hypertension
  • Cut off level
  • Period of observation
  • Indications - diabetics

- chronic kidney disease

- target organ damage

- multiple risk factors

- vascular disease

  • Choice of drugs
difficult hypertension
Difficult Hypertension
  • Compliance
  • Diet
  • Secondary cause
  • Diuretic
slide19

Thank You

Health

is

Wealth

ad