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CKM Syndrome

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November 14, 2024

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.

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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.

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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

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