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RISK FACTOR PROFILE AND CONTROL IN TYPE 2 DIABETES AT KNH

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

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RISK FACTOR PROFILE AND CONTROL IN TYPE 2 DIABETES AT KNH

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  1. 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

  2. TYPE 2 DIABETES • Progressive disease • Well characterized . . . • But-poorly controlled • Broad treatment goals:-glycaemia,BP,LDL,Weight,Knowledge,Selfmanagement,HRQoL etc

  3. RISK FACTORS OF COMPLICATIONS Microvascular Hyperglycaemia Genetics (Hypertension) Macrovascular Lipids Hypertension Genetics Age

  4. COMPLICATION PROFILES AT KNH Microvascular • Eye • Neuropathy • Nephropathy • Microalbuminuria • Macroalbuminuria • ESRD

  5. MACROVASCULAR COMPLICATIONS • Cerebrovascular disease (Mwazo) • Myocardial infarction (Nguchu) (STEMI/NSTEMI) • Erectile dysfunction (Ngalyuka)

  6. 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)

  7. RISK FACTOR PROFILE AT KNH • Glycaemiccontrol: <40% good control • BP control – only 50% known HTN, out of these only 25% well controlled. • Lipids - high LDL • Adherence to treatment – POOR

  8. 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

  9. CONSEQUENCES OF POOR CONTROL • Enhanced complications ( at early age) • Renal • Cardiac • Stroke • Attenuated HRQoL • Health resource consumption-hospitalization; dependance.

  10. 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?

  11. 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

  12. 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 ?

  13. THANK YOU

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