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

Non Communicable Diseases

Diabetes Hypertension Ischaemic Heart Disease Stroke Rheumatic Heart Disease Cancers

Non- communicable

diseases 82%

Communicable, maternal and

perinatal diseases

10%

Injury and poisoning

8%

Distribution of Deaths in Fiji - 2000

I

N

C

I

D

E

N

C

E

Communicable diseases

Non-communicable diseases

Ancient Past 1700s Present

Disease Trends in the Pacific

Fiji Step Survey 2002

Diabetes - 16%

Hypertension - 19

Weight : Obese - 18

Overweight - 28

Hyperlipidaemia F/M 38/49

Fiji NCD Steps Survey 2002

Sample Population

• 6,783 participants

• M 53%; F 47%

• 15 – 64 years

Sample Population

• 6,783 participants

• M 53%; F 47%

• 15 – 64 years

Percentage

16

18

19

26

29

37

38

45

49

65

66

76

0 20 40 60 80

Diabetes

Obesity

HTN

Vegetable

Overweight

Smoking

↑ Chol, F

Alcohol

↑ Chol, M

Kava

Fruit

Inactive

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

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

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%

Early Insulin Therapy

• Microvascular

• Macrovascular

• Beta cell function

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

Early Detection Protein restriction ACE Inhibitors Hyperglycaemia Hypertension Hyperlipidaemia Other vascular risk factors

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

Compliance

Diet

Secondary cause

Diuretic

Cerebral Autoregulation

Coronary Artery Disease

Angiogram – SPH CABG Angiogram Suite

Health is Wealth

Thank You