What are the latest evidence‑based pharmacologic, technological, and preventive strategies for managing non‑communicable diseases such as cardiovascular disease, type 2 diabetes, cancer, chronic respiratory disease, and mental health disorders?

Recent Advances in Non-Communicable Disease Management

The most transformative recent advance in NCD management is the integration of SGLT2 inhibitors as cornerstone therapy across cardiovascular disease, diabetes, chronic kidney disease, and obesity, combined with structured multidisciplinary care programs that reduce hospitalizations and improve guideline-directed medical therapy adherence. 1

Pharmacologic Advances

SGLT2 Inhibitors as First-Line Therapy

• SGLT2 inhibitors now represent the cornerstone pharmacologic intervention for patients with concurrent heart failure, CKD, diabetes, and obesity, reducing cardiovascular mortality, heart failure hospitalizations, and CKD progression regardless of diabetic status. 1
• This represents a paradigm shift from traditional disease-specific treatment to integrated cardio-renal-metabolic management. 1

Optimized Blood Pressure Management

• Target blood pressure <130/80 mmHg for most patients with diabetes, with intensive targets (<120 mmHg systolic) providing additional 25% reduction in cardiovascular events and 27% reduction in mortality in high-risk populations. 2
• The ADVANCE trial demonstrated that achieving mean SBP/DBP of 136/73 mmHg reduced major cardiovascular events by 9%, cardiovascular death by 18%, and all-cause mortality by 14%. 2
• ACE inhibitors or ARBs remain first-line therapy in patients with diabetes and hypertension, particularly those with albuminuria or chronic kidney disease. 2

Advanced Heart Failure Therapy

• ARNI (sacubitril-valsartan) should be initiated first for HFrEF, providing superior cardiovascular outcomes and favorable renal effects compared to traditional ACE-I/ARB therapy. 1
• Beta-blockers and mineralocorticoid receptor antagonists must be titrated to target doses with careful potassium monitoring, especially in CKD. 1

Technological and Digital Health Innovations

Mobile Health (mHealth) Technologies

• mHealth technologies demonstrably support self-management across diabetes, cancer chemotherapy symptom management, asthma, cognitive disabilities, chronic self-harm, and ADHD through person-centered functionality that aligns with young people's current technology habits. 3
• End users uniquely perceive mHealth as empowering them to more independently manage their chronic health conditions. 3
• Implementers must undertake continuous cycles of improvement to maintain technical and functional optimization, with planned review cycles necessary for iteration based on analytics data. 3

Key Implementation Requirements

• Co-design of mHealth technologies with end users is essential for acceptance and sustained engagement. 3
• Functional aspects must support behavior change, provide real-time monitoring, and integrate with existing clinical workflows. 3
• Apps and wearable devices should be encouraged to motivate and monitor physical activity, with any amount of activity providing benefit. 3

Preventive and Lifestyle Strategies

Physical Activity Recommendations

• Prescribe ≥150 minutes per week of moderate-intensity aerobic activity plus resistance training; even 5-10 minutes daily walking confers measurable benefit. 3, 1
• Exercise referral schemes are among the most promising methods of promoting physical activity in adults with NCDs. 3
• Cardiac rehabilitation provides the optimal supervised setting for exercise in patients with cardiovascular disease. 1

Nutrition and Sleep Optimization

• A lifelong, individualized nutrition plan emphasizing fruits, vegetables, whole grains, lean protein, and limiting processed foods, saturated fat, salt (<2.0 g/day), and sugar is mandatory. 2, 1
• Dietary sodium restriction to <2.0 g/day is synergistic with ACE inhibitor/ARB therapy and essential for blood pressure control. 2
• Ensure 7-9 hours nightly sleep; sleep deprivation worsens insulin resistance, hypertension, hyperglycemia, dyslipidemia, and increases inflammatory cytokines. 3, 1

Critical Lifestyle Interventions

• Smoking cessation is the single most important lifestyle intervention, with clinician encouragement cited as a frequent motivator to quit. 3, 1
• Limit alcohol to ≤1 drink/day (women) or ≤2 drinks/day (men) to prevent weight gain, hypertension, cardiomyopathy, atrial fibrillation, peripheral neuropathy, fatty liver, and dementia. 3, 1

Patient Education and Self-Management

Structured Education Framework

• Self-management education improves psychological, clinical, and lifestyle outcomes and should be provided at every clinic visit. 3
• Patients must "know and understand their numbers": BMI, A1C, time in range (TIR), fasting plasma glucose, blood pressure, LDL-C, ApoB, triglycerides, HDL-C, non-HDL-C, FIB-4, eGFR, and UACR. 3

Shared Decision-Making Approach

• Elicit patient's priorities and emphasize early and aggressive treatment through open-ended questions. 3
• Encourage belief that patients can control health outcomes while avoiding judgmental language. 3
• Provide education incrementally rather than attempting to cover all topics at once, with repetition and reinforcement at each visit. 3

Health Literacy Considerations

• Evaluate and consider health literacy levels when communicating. 3
• Account for socioeconomic factors and other social determinants of health in treatment planning. 3

Integrated Care Delivery Models

Multidisciplinary Team Structure

• Cardiologists and nephrologists jointly titrate guideline-directed medical therapy and monitor drug-disease interactions. 1
• Primary care physicians coordinate overall care and manage additional comorbidities. 1
• Social workers and psychologists address mood disturbances that affect treatment adherence; early mental-health assessment and referral to specialized care are essential. 1

Structured Disease-Management Programs

• Enroll all patients in structured disease-management programs that provide coordinated multidisciplinary care, continuous education, and remote monitoring; such programs reduce hospitalizations, improve GDMT adherence, and enhance quality of life. 1
• A team-based communication model (interprofessional group decision-making) demonstrates superior outcomes compared with a consultative-only approach. 1
• High-risk patients should receive intensive follow-up using specialized nurse support, telephone monitoring, remote telemetry, group visits, or video consultations. 1

Monitoring and Follow-Up Protocols

Renal Function Surveillance

• Renal function (serum creatinine, eGFR, electrolytes) should be monitored closely during GDMT initiation; modest creatinine rises (<30% from baseline) do not mandate ACE-I/ARB discontinuation unless accompanied by hyperkalemia or symptomatic hypotension. 1

Volume Status Assessment

• Volume status assessment should combine clinical exam with point-of-care ultrasound, Venous Excess Ultrasound score, and echocardiography; right-heart catheterization is advised when non-invasive data are inconclusive. 1
• Serial measurement of cardiac biomarkers (BNP/NT-proBNP) and renal markers guides therapy adjustments. 1

Priority NCDs in Crisis Settings

Disease Prioritization Framework

• Prioritize cardiovascular disease, diabetes mellitus, chronic respiratory diseases, mental health disorders, chronic kidney disease, musculoskeletal diseases, cancers requiring ongoing treatment, epilepsy, cirrhosis, and severe heart failure in crisis settings, based on global burden and crisis-specific vulnerability. 4
• Ischemic heart disease and hypertension represent the leading NCD burden globally and in crisis-affected regions, with hypertension being particularly prevalent in displaced populations. 4

Critical Interventions During Crises

• Ensure continuity of insulin access and blood glucose monitoring devices for diabetes management in crisis settings. 4
• COPD and asthma require ongoing medication access and monitoring, making them high-priority in crisis settings. 4
• Mental disorders, including depression and PTSD, represent major causes of disability in crisis-affected populations, particularly with conflict exposure. 4

Common Pitfalls and How to Avoid Them

Medication Safety

• Avoid NSAIDs entirely, as they exacerbate kidney injury and impair sodium excretion. 1
• Never use diuretics as monotherapy; always combine with ACE-I/ARB (or ARNI) and beta-blocker when tolerated. 1
• Recognize the high risk of drug-drug and drug-disease interactions in patients with multiple comorbidities; vigilant monitoring is mandatory. 1

Patient Adherence Strategies

• Adopt an attitude of empathetic reinforcement, providing positive feedback for blood pressure and behavioral improvements, and scheduling more frequent appointments for patients not achieving goals. 2
• Assess patient's understanding and acceptance of their diagnosis, discussing concerns and clarifying misunderstandings at each visit. 2
• Tell patients their blood pressure reading and provide written documentation, coming to agreement on goal BP and asking patients to rate (1-10) their likelihood of adhering to treatment. 2