Non-communicable diseases are long-term ailments, often lifelong in duration. The main types (about 80%) of NCDs are cardiovascular diseases, diabetes, cancers, and chronic respiratory conditions. The other 20% of NCDs include a very wide range of mental and bodily disorders that may affect individuals either alone or as co-morbidities.
NCDs are the result of a combination of genetic, physiological, environmental and behavioural factors. The latter include tobacco use, excess alcohol intake, unhealthy diet with high sugar and salt intake, physical inactivity, and ambient pollution. These are increasingly augmented by the secondary consequences of worldwide trends such as rapid unplanned urbanization, globalisation of unhealthy lifestyles, and ageing.
NCDs are not just medical problems. They have huge personal, social and economic impacts as the people affected are often at the peak of their productive careers and precious investment has already been made in their education and training. Their premature demise or impaired productivity due to long-term sickness or chronic disabilities can impoverish them and their families and dependents. NCDs have already become a major burden on health and social support systems, and a brake to national development.
Diabetes mellitus is an acutely life-threatening as well as a chronic condition in which high blood sugar over a long period of time can cause many and serious complications such as heart disease, stroke, kidney failure, eye damage leading to blindness, and difficult-to-treat ulcers that can require limb amputation.
Diabetes is due to specialised cells in the pancreas not producing enough insulin (Type I) or body cells not responding properly to them (Type 2). Type I (10% of all diabetics) is not preventable with current knowledge and requires insulin injections without which death within a few days is inevitable. Type 2 (90% of diabetics) is treated with oral medication but may also need insulin. Diabetes is partly inherited genetically but lifestyle factors such as obesity, high sugar consumption, and low exercise levels are strong contributors.
In addition, gestational diabetes can occur during pregnancy where there is hyperglycemia i.e., blood glucose values above normal but below that of diabetes. Women with gestational diabetes are at increased risk of complications during pregnancy and at delivery. They and their children are also at greater future risk of Type 2 diabetes. Gestational diabetes is diagnosed through prenatal screening and insulin may be required to manage it, if dietary measures don’t work.
Hypertension is a long-term condition that occurs when the pressure of the blood pushing against the walls of blood vessels (arteries), is consistently too high. Also known as a ‘silent killer” because it does not usually cause symptoms, the untreated complications include coronary heart disease, heart failure, stroke, and peripheral vascular disease, as well as renal and visual impairment that can lead, in extreme cases, to kidney failure and blindness. Hypertension is also a risk factor for cognitive impairment such as in dementia, itself a major problem of ageing populations.
90-95% of hypertension is classified as primary high blood pressure due to lifestyle and genetic factors. The remaining cases are secondary to specific identifiable causes. One of these is a particularly dangerous form of high blood pressure that occurs in pregnancy: pre-eclampsia and eclampsia. This can arise as an emergency and kill both mother and baby. Women who suffer from this may have gestational diabetes too, and tend to develop chronic hypertension and diabetes later on in life.
If hypertension is picked up through screening programmes or discovered incidentally while investigating other conditions, it can be easily controlled through lifestyle changes (obesity and dietary salt reduction, exercise, not smoking and managing stress) and oral anti-hypertensive medication. Some form of medication usually become necessary to prevent progression and complications. Depending on the stage of the hypertension, there are several drug types and combinations available to optimise treatment on an individual basis.