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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

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Clinical Issues in the Management of Non Communicable Diseases

Dr Gyaneshwar Rao

Colonial War Memorial

Hospital

Suva


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Presentation Outline

  • NCD Conditions

  • Fiji Step Survey 2002

  • Diabetes and Related Issues

  • Fiji Dialysis Centre

  • Hypertension

  • Coronary Angiographic Services


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Non Communicable Diseases

  • Diabetes

  • Hypertension

  • Ischaemic Heart Disease

  • Stroke

  • Rheumatic Heart Disease

  • Cancers


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Distribution of Deaths in Fiji - 2000


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Disease Trends in the Pacific

I

N

C

I

D

E

N

C

E

Communicable diseases

Non-communicable diseases

Ancient Past1700sPresent


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Fiji Step Survey 2002

Diabetes - 16%

  • Hypertension - 19

  • Weight : Obese - 18

    Overweight - 28

  • Hyperlipidaemia F/M 38/49


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Fiji NCD Steps Survey 2002

  • Sample Population

  • 6,783 participants

  • M 53%; F 47%

  • 15 – 64 years

Percentage


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Screening for Type 2 Diabetes

  • Preclinical phase : 10 – 12 yrs

  • Tight Control : Micro/Macrovascular

  • Screening (FBS) : Symtomatic

    : Asymptomatic

  • Pre diabetics - studies, long term


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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


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Microvascular

- Eye

- renal

- neuropathy

Macrovascular

- coronary, PVD

- cerebrovascular

- renovascular

Assessing Diabetic Complications


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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%


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Early Insulin Therapy

  • Microvascular

  • Macrovascular

  • Beta cell function


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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)


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Diabetic Nephropathy

  • Early Detection

  • Protein restriction

  • ACE Inhibitors

  • Hyperglycaemia

  • Hypertension

  • Hyperlipidaemia

  • Other vascular risk factors


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Mild Hypertension

  • Cut off level

  • Period of observation

  • Indications - diabetics

    - chronic kidney disease

    - target organ damage

    - multiple risk factors

    - vascular disease

  • Choice of drugs


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Difficult Hypertension

  • Compliance

  • Diet

  • Secondary cause

  • Diuretic


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Cerebral Autoregulation


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Angiogram – SPH

CABG

Angiogram Suite

Coronary Artery Disease


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Thank You

Health

is

Wealth


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