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 Past 1700s Present
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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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Assessing Diabetic Complications

• Microvascular
• - Eye
• - renal
• - neuropathy
• Macrovascular
• - coronary, PVD
• - cerebrovascular
• - renovascular

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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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Coronary Artery Disease

• Angiogram SPH
• CABG
• Angiogram Suite

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Thank You
Health is Wealth