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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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Non- communicable
diseases 82%
Communicable, maternal and
perinatal diseases
10%
Injury and poisoning
8%
Distribution of Deaths in Fiji - 2000
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I
N
C
I
D
E
N
C
E
Communicable diseases
Non-communicable diseases
Ancient Past 1700s Present
Disease Trends in the Pacific
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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
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
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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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Health is Wealth
Thank You