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Clinical Issues in the Management of Non Communicable Diseases

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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  1. Clinical Issues in the Management of Non Communicable Diseases Dr Gyaneshwar Rao Colonial War Memorial Hospital Suva

  2. Presentation Outline • NCD Conditions • Fiji Step Survey 2002 • Diabetes and Related Issues • Fiji Dialysis Centre • Hypertension • Coronary Angiographic Services

  3. Non Communicable Diseases • Diabetes • Hypertension • Ischaemic Heart Disease • Stroke • Rheumatic Heart Disease • Cancers

  4. Distribution of Deaths in Fiji - 2000

  5. Disease Trends in the Pacific I N C I D E N C E Communicable diseases Non-communicable diseases Ancient Past 1700s Present

  6. Fiji Step Survey 2002 Diabetes - 16% • Hypertension - 19 • Weight : Obese - 18 Overweight - 28 • Hyperlipidaemia F/M 38/49

  7. Fiji NCD Steps Survey 2002 • Sample Population • 6,783 participants • M 53%; F 47% • 15 – 64 years Percentage

  8. Screening for Type 2 Diabetes • Preclinical phase : 10 – 12 yrs • Tight Control : Micro/Macrovascular • Screening (FBS) : Symtomatic : Asymptomatic • Pre diabetics - studies, long term

  9. 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

  10. Microvascular - Eye - renal - neuropathy Macrovascular - coronary, PVD - cerebrovascular - renovascular Assessing Diabetic Complications

  11. 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%

  12. Early Insulin Therapy • Microvascular • Macrovascular • Beta cell function

  13. 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)

  14. Diabetic Nephropathy • Early Detection • Protein restriction • ACE Inhibitors • Hyperglycaemia • Hypertension • Hyperlipidaemia • Other vascular risk factors

  15. Mild Hypertension • Cut off level • Period of observation • Indications - diabetics - chronic kidney disease - target organ damage - multiple risk factors - vascular disease • Choice of drugs

  16. Difficult Hypertension • Compliance • Diet • Secondary cause • Diuretic

  17. Cerebral Autoregulation

  18. Angiogram – SPH CABG Angiogram Suite Coronary Artery Disease

  19. Thank You Health is Wealth

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