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. INCIDENCEINCIDENCE Communicable diseases Non-communicable diseases Ancient Past1700sPresent Disease Trends in the Pacific

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

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 Microvascula r 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. Coronary Artery Disease  Angiogram – SPH  CABG  Angiogram Suite

19. Health is Wealth Thank You