Chronic Disease Management

Chronic Disease Overview - The Long Haul

• Definition: Conditions of long duration & slow progression, requiring ongoing medical attention or limiting activities of daily living.
• Burden (India): Non-Communicable Diseases (NCDs) cause ~63% of all deaths. Major NCDs: cardiovascular diseases, diabetes, chronic respiratory diseases, cancers.
• Goals of Chronic Disease Management (CDM):
  • Improve patient Quality of Life (QoL) & functional status.
  • Prevent/delay complications & disease progression.
  • Promote patient self-management, education & adherence.
  • Optimize resource utilization for cost-effective care.
  • Integrated, patient-centered, team-based approach.

⭐ India aims to reduce premature mortality from NCDs by 25% by 2025 (aligns with WHO "25x25" global target).

Key Players: DM & HTN - Sugar & Pressure Saga

• Diabetes Mellitus (DM):
  • Screen: Indian adults >30y, or BMI >23kg/m² + risk factors.
  • Dx: FPG ≥126, 2h-PG(75g OGTT) ≥200, HbA1c ≥6.5%, RPG ≥200+symptoms. (mg/dL for PG values)
  • Targets: HbA1c <7% (indiv.); FPG 80-130mg/dL.
• Hypertension (HTN):
  • Screen: All adults ≥18 yrs.
  • Dx: Clinic BP ≥140/90 mmHg (avg ≥2 readings, ≥2 occ.). Confirm HBPM/ABPM.
  • Targets: General <140/90; High-risk (DM, CKD) <130/80 mmHg.
• 📌 ABCDE of DM care: A1c, Blood pressure, Cholesterol, Diet/Drugs, Exercise/Eye exam.
• Target Organ Damage (TOD): Retinopathy, Nephropathy, Neuropathy, CAD, Stroke.

⭐ In HTN with compelling indications like DM, ACE inhibitors or ARBs are preferred first-line agents due to renal protective effects.

Lifestyle & Adherence - Daily Dose of Wellness

• Diet:
  • DASH: Fruits, vegetables, low-fat dairy; ↓Na (<2.3g/day, ideal <1.5g/day), ↓sat fat.
  • Mediterranean: Healthy fats, nuts, fish.
• Exercise:
  • Aerobic: ≥150 min/mod or ≥75 min/vigorous weekly.
  • Strength: ≥2 days/week.
• Weight: Target BMI 18.5-24.9 kg/m².
• Smoking Cessation: 5 A's (Ask, Advise, Assess, Assist, Arrange). NRT, Varenicline.
• Alcohol: Limit: ≤1 drink/day (women), ≤2 (men).
• Adherence:
  • Simplify regimen (📌 KISS).
  • Educate, motivate. Regular follow-up.

  ⭐ Non-adherence to treatment plans for chronic diseases can be as high as 50-60%.

Monitoring & Complications - Eye on the Prize

• Goal: Early detection & management of complications.
• Diabetes Mellitus (DM):
  • Targets: HbA1c <7%, BP <130/80 mmHg, LDL <100 mg/dL (or <70 mg/dL if CVD).
  • Microvascular: Retinopathy (annual fundoscopy), Nephropathy (annual UACR >30 mg/g), Neuropathy (annual foot exam).
  • Macrovascular: Coronary Artery Disease (CAD), Stroke, Peripheral Artery Disease (PAD).
• Hypertension (HTN):
  • Targets: BP <140/90 mmHg; <130/80 mmHg (DM, CKD, high ASCVD risk).
  • End-Organ Damage: Left Ventricular Hypertrophy (LVH) (ECG), Chronic Kidney Disease (CKD) (KFT, urine), Retinopathy, Stroke.
• Red Flags (Referral):
  • Vision loss, chest pain, foot ulcers, neurological deficits, worsening renal function.

⭐ Microalbuminuria (UACR 30-300 mg/g) is the earliest detectable stage of diabetic nephropathy.

High‑Yield Points - ⚡ Biggest Takeaways

• Diabetes: Target HbA1c <7%; metformin first-line; manage DKA/HHS.
• Hypertension: Target BP <130/80 mmHg; lifestyle modification is key.
• COPD/Asthma: Spirometry for diagnosis; stepwise management; avoid triggers.
• CKD: GFR staging; control BP & glucose; manage anemia.
• CAD: Risk factor control; statins & antiplatelets are vital.
• Heart Failure: NYHA classification; ACEi/ARBs, beta-blockers crucial.
• Multimorbidity: Patient-centered approach; review polypharmacy regularly.