CKM Syndrome

Why in News?

World Diabetes Day is observed on November 14.

What is CKM syndrome?

• CKM Syndrome – It is a complex disorder made up of cardiovascular disease, kidney disease, obesity and Type 2 diabetes.
• Obesity and Type 2 diabetes are metabolic conditions and each of the four conditions in CKM syndrome can lead to or worsen one another.
• Symptoms - CKM syndrome symptoms may include any of the issues you get with the four conditions that make up cardiovascular-kidney-metabolic syndrome.
  • Chest pain.
  • Shortness of breath.
  • Syncope (passing out).
  • Swelling in your legs, feet, hands or ankles.
  • Pain in your legs while walking.
  • Tiredness.
  • Loss of appetite or an increase in appetite.
  • The need to pee more often.
  • Dry skin.
  • Sleep apnea.
  • Gout.
• Insidious Growth – It is often marked by a gradual rise in body weight and waist circumference that soon escalates into obesity, setting off a chain reaction in the body.
• Premature Death Vulnerability - Major organs such as the heart, the kidneys, liver and blood vessels bear the brunt, leaving those affected vulnerable to premature death.
• NCD Burden – As per Global Burden of Disease (GBD), the burden of non-communicable diseases (NCDs) account for 69% of premature deaths and 68% of years lost to disability.
• India NCD Burden – As per National Family Health Survey (2019-21)
  • Diabetes prevalence -  16.1%
  • Obesity -  40.3%
  • Hypertension — 24% of men and 21% of women

• Tamilnadu NCD Burden -  As per 2020 Tamil Nadu STEPS survey,
  • Overweight - 28.5%
  • Obesity - 11.4%
  • Hypertension - 33.9%
  • Diabetes - 17.6%

The WHO STEPwise approach to NCD risk factor surveillance (STEPS) is a simple, standardized method for collecting, analysing and disseminating data on key NCD risk factors in countries.

What are the reasons for high prevalence of CKM ?

• Influence of Globalisation - Long work hours, night shifts, ignoring our need for rest, idolising workaholism.
• Unhealthy Lifestyle - Long working hours and frequent night shifts lead to brain fatigue and reduced secretion of happy hormones, often counterbalanced by eating super-palatable foods which are rich in salt, sugar and butter.
• Extended Work Hours - It disrupts hormone levels, with cortisol (the “stress hormone”) driving unhealthy carbohydrate and lipid metabolism.
• Poor Glycemic Control - Distribution of rice, a high glycemic food, through the Public Distribution System (PDS), has contributed to obesity.
• Poverty - Low socioeconomic status is associated with use of tobacco and alcohol, physical inactivity, and poor diet.

What are the challenges?

• Lack of Holistic Risk Assessment – Current health management models miss key opportunities for optimal, holistic risk assessment.
• Fragmented Care - Patients with multiple affected organs see separate specialists for each issue, leading to, drug interactions, repeated visits, and, ultimately, a loss in wages and productivity.
• Inadequate Management - Less than one-fourth of the affected individuals receives any measure of controlling their blood pressure.
• Low Awareness – Lack of awareness among people about the causes, impacts of NCDs and unhealthy lifestyle practices.

What are the impacts?

• Current trends of rising obesity, diabetes, and hypertension rates threatens SDG  Targets, health budget and the economy as a whole.

SDG Target 3.4 - By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

• Premature Death - In India, noncommunicable diseases (NCDs) account for approximately 64% of all deaths, adversely affecting not only people’s health.
• Economic Impact – The economic loss attributed to NCDs (excluding mental health) in India is projected to reach US $3.55 trillion between 2012 and 2030.
• Health Budget - Coronary angioplasty and dialysis tops the list of claims under the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) of Tamilnadu and Ayushman Bharat Health Insurance.
• Household Financial Instability – NCD associated mortality and morbidity affects leads to loss of income and  increased out-of-pocket expenses for treatment and care.

What are the government measures in tackling NCD?

• NPCDCS - National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) is being implemented in all States across the country with the focus on
  • Strengthening of infrastructure
  • Development of human resource
  • Emphasis on health promotion
  • Early diagnosis, management and referral.

Under NP-NCD, 724 District NCD Clinics, 210 Cardiac Care Centre, 326 District Day Care Centres and 6110 Community Health Centres NCD Clinics have been set up.

• PBS - Population based prevention and control, screening and management initiative for common NCDs is being implemented under Health Wellness Centre in National Health Mission (NHM).
• National NCD Portal – It provides for implementation of PBS for prevention, control, Screening and management of the population-based screening of common NCDs.
• National Multi-Sectoral Action Plan for Prevention And Control of Common NCDs – It offers a road map and menu of policy options to guide multi-sectoral efforts involving other Ministries/Departments towards attaining the NCD targets.
• Whole of Society Approach - India is proceeding towards the illness to wellness concept with the “Whole of Government and Whole of Society” approach.
• Digital Health Technologies - Telemedicine, mobile health applications, and data analytics can enhance patient engagement, improve access to care, and facilitate monitoring and evaluation.
• Ayushman Bharat Health Account Number (ABHA-ID) - It is being maintained and tracking of every single individual with NCDs is done through National NCD Portal.
• National Health Policy 2017 - It stipulates the target of relative reduction of 15% in tobacco use by 2020 and of 30 % by 2025, from the baseline levels of 2010.
• Fit India Movement – It is a nation-wide movement in India to encourage people to remain healthy and fit by including physical activities and sports in their daily lives.
• Eat Right Movement – It was launched by FSSAI , to improve public health in India and combat negative nutritional trends to fight lifestyle diseases.
• ICMR Dietary Guidelines – It provides 17 dietary guidelines to meet the requirements of essential nutrients and prevent non-communicable diseases (NCDs) such as obesity and diabetes.

What lies ahead?

• Integrated care for CKM , shifting from segmented care to unified, simultaneous management of risk factors.
• Rather than isolating diabetes, hypertension, heart disease, and kidney disease, they should be viewed as symptoms of a broader metabolic condition.
• An integrated clinic could address these issues, with a multidisciplinary team of a diabetologist, cardiologist, nephrologist, dietician and physiotherapist working together.
• Regular weight and obesity screenings ff preschool through secondary schoolchildren to identify high-risk individuals early.
• Partial replacement of rice in the PDS with millets to diversify the diet and reduce the high glycemic food.
• Regulation of work hours and shifts is as essential a public health measure as any medical intervention.
• Create awareness among people about the necessity of healthy diets.

Reference

The Hindu | CKM Syndrome