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DIETARY PRACTICES THAT CONTRIBUTE TO HEALTHY AGEING AMONG DIABETIC PATIENTS

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ABSTRACT

The study determined the dietary pattern that contributes to healthy ageing among diabetic patients in Abia State. To carry out this research work, four research questions were raised and four hypotheses were tested at 0.05 level of significance. Specifically, the objective of the study includes; identifying the types of meals that are mostly consumed by diabetic patients in Abia State, determining the reasons for choice of meal among ageing diabetic patients, determining the major problem of diabetic patients in Abia State and ways of improving the dietary pattern of diabetic patients in Abia State. It was a descriptive survey design, in which copies of questionnaire were administered.  The respondents were consented adult of diabetic patients from the two tertiary health facilities in Abia State since most of the patients were likely to be referred to these tertiary facilities. Proportionate random sampling techniques were used on a population of 2412 diabetic patients that visited the two major hospitals for routine check-up. A sample size of 343 were considered, after which the 343 patients were stratified among the two major hospitals in Abia State (Federal Medical Centre Umuahia and Abia State Teaching Hospital Aba). The data obtained from the following research questions; types of meal the diabetic patients consumed, the reasons for the choice of meal the diabetic patients take, the problems of diabetic patients, how to improve the dietary pattern of a diabetic patients, were computed using Statistical Package for Social Sciences (SPSS version 20) and results are expressed as percentage, frequencies, and mean score ratings. The formulated hypotheses were tested at 5% level of significance using T-test. The total number of respondents were 343 of which is 161 (46.9%) and 182 (53.1%) were males and females respectively. The findings of the study revealed among others that the respondents consumed mainly, vegetable, fish, fruits, garri and soup, meat beans and plantain due to medical advice. Forty nine (14.29%) out of the 343 patients did not report any complications. Most commonly reported complications/problems among the patients were hypertension, retinopathy, neuropathy and ulcer. The study showed that meat was significantly highly consumed among patients aged <55 years, while consumption of rice and plantain were significantly higher among patients aged 55 years and above. Consumption of garri/soup and plantain were significantly higher among patients without complications than among patients with complications. Since the study showed that plantain was consumed significantly more in patients 55years and above and higher in patients without complications. The study therefore recommends that awareness should be created by the Hospital on the types of meals that should be consumed by diabetic patients. The Federal and State governments should equip the laboratories for the proper testing of diabetic patients.








TABLE OF CONTENTS


Title Page                                                                                                                    i

Declaration                                                                                                                 ii

Certification                                                                                                               iii

Dedication                                                                                                                  iv

Acknowledgements                                                                                                    v

Table of Contents                                                                                                       vi

List of Tables                                                                                                              ix

Abstract                                                                                                                      x

 

CHAPTER 1: INTRODUCTION                                                                            1

1.1       Background to the Study                                                                                1

1.2       Statement of the Problem                                                                               7

1.3       Purpose/Objectives of the Study                                                                    10

1.4       Research Questions                                                                                        10

1.5       Hypotheses                                                                                                     10

1.6       Scope of the Study                                                                                          11

1.7       Significance of the Study                                                                               11

1.8       Definition of Terms                                                                                        13

 

CHAPTER 2: REVIEW OF RELATED LITERATURE                                     15

2.1       Conceptual Framework                                                                                  15

2.1.1    Healthy dieting for diabetic patients                                                              17

2.1.2    Concept of self - management of diabetes                                                     23

2.1.3    Unhealthy dieting and diabetes                                                                      24

2.1.4    Dietary habits for healthy ageing                                                                   25

2.1.5    Diabetes – types, causes and factors associated with diabetic patients           25

2.2       Theoretical Framework                                                                                  32

2.2.1    Atkins diet theory                                                                                           33

2.2.2    Continuity theory                                                                                            33

2.2.3    Activity theory                                                                                                33

2.2.4    Disengagement theory                                                                                    33

2.2.5    Mitochondrial theory                                                                                      34

2.2.6    Misrepair accumulation theory                                                                       35

2.3       Review of Empirical Studies                                                                          36               

2.4       Summary and Gaps in Literature Review                                                      40

 

CHAPTER 3: METHODOLOGY                                                                          40

3.1       Research Design                                                                                             43

3.2       Area of the Study                                                                                            43

3.3       Population for the Study                                                                                 44

3.4       Sample and Sampling Technique                                                                   45

3.5       Instrument for Data Collection                                                                       46

3.6       Validation of the Instrument                                                                          47

3.7       Reliability of the Instrument                                                                          47

3.8       Methods of Data Collection                                                                           48

3.9       Method of Data Analysis                                                                                48

 

CHAPTER 4: RESULT AND DISCUSSION                                                         49

4.1       Results                                                                                                            49

4.1.1    Research question 1                                                                                        51

4.1.2    Research question 2                                                                                        52

4.1.3    Research question 3                                                                                        52

4.1.4    Research question 4                                                                                        54

4.1.5    Hypothesis 1                                                                                                   55

4.1.6    Hypothesis 2                                                                                                   57

4.1.7    Hypothesis 3                                                                                                   58

4.1.8    Findings of the study                                                                                      59

4.2       Discussion                                                                                                       61

 

CHAPTER 5: SUMMARY, CONCLUSION AND RECOMMENDATIONS     67

5.1       Summary of the Study                                                                                    67

5.2       Conclusion                                                                                                      68

5.3       Implication of the Findings                                                                            69

5.4       Recommendations                                                                                          70

5.5       Suggestions for Further Studies                                                                     70

References                                                                                                      71

Appendices                                                                                                     82

 

 

 

 

 

LIST OF TABLES

  

3.1:      Stratified random sampling of diabetic patients that visited FMC

Umuahia and Abia State University Teaching Hospital as at 2015                        46  

 

4.1:      Socio demographic characteristics                                                                 49

 

4.2:      Mean ratings of respondents and types of meals consumed by diabetic

patients                                                                                                           51

 

4.3:      Mean ratings of respondents on reasons for choice of meal taken by

patients                                                                                                           52

4.4A:   Meaning ratings of respondents on the biological problems of diabetic patients                                                                    52

 

4.4B:   Meaning ratings of respondents on the physical problems of diabetic

patients                                                                                                           53

 

4.5:      Mean ratings of the respondents on the ways of improving the dietary 54

 

4.6:      T-test result of the mean ratings of young and old diabetic patients on the

types of meals consumed.                                                                               55

 

4.7:      T-test result of the mean ratings of presence of problems among diabetic

patients on the types of meals consumed.                                                      56

 

4.8:      T- test result on reasons for choice of food and educational status                        57

 

4.9:      T- test result of the problems associated with diabetes mellitus and

gender                                                                                                             58

 

 


 


 

 

CHAPTER 1

INTRODUCTION

 

1.1       BACKGROUND TO THE STUDY

Ageing could be defined as transitional process of becoming older with time. This represents the accumulation of total changes in a person over time. Ageing brings about changes in physical, psychological and social processes, so it is a multi-dimensional process. Due to the reflecting effect it has on the biological changes, this makes it an important part of all human societies, though it also reflects cultural and social conventions. Ageing can also be defined as the process of making optimal use of opportunities for health participation and security. In developed countries, the life expectancy of individual increases and birth rates decline, so as the middle age increases simultaneously; this process is occurring in every country in the world (Leonard, 2004). By some estimates, a person’s basal metabolism drops by 2 per decade, starting at the age of 20. Some researchers believe that this decline is due almost solely to the loss of muscle mass that comes with age, (Clarke et al; 2004).

 

As the years, the body system continuously becomes less adaptive at taking up and using glucose from the blood stream, a situation known as “glucose intolerance”, this trigger the development for diabetes, and one factor that is contributing to glucose intolerance is a condition known as “insulin resistance”, in which people’s body tissues become less and less sensitive to insulin. However, ageing may not necessarily be a burden and as such does not necessarily reduce the ability of individual contributing to society and enjoy a high quality of life, (Dullin, et al; 2014).

 

Health, diet and exercise habits contribute to healthy ageing. Certain types of diet can prevent and may decrease the risk of disease, (Hemann and Greide, 2000). According to Gensler, et al; (2008) to ensure adherence, it is important to increase slowly the frequency, duration and intensity of exercise, and to find physical exercise that is proper for the person. A modified exercise and proper diet is a better way of promoting good health while becoming old. In order to prevent disease and malfunction of the body system, as well as increase longevity and promotes one’s quality of life as one age. It is better to engage in appropriate physical exercise, having healthy diet, avoid smoking, not using alcohol and using medication wisely, (Bartka, 2011).

 

Healthy ageing is a function of variety of influences that surround group of peoples and their environment at large. They include material conditions as well as social, cultural, economic and environmental factors. All of these factors and the interaction between them, has an important role to play in determining how well people age, therefore healthy ageing includes the life style influence, like a healthy diet and regular physical activity as well as access to and use of health information and services, (Timiras and Paola, 2003).

 

Healthy ageing is a term which is often interchangeable with descriptions such as active ageing, successful ageing, positive ageing and productive ageing. Although there is a general acceptance that healthy ageing of individuals involves beyond physically and mentally health issues, (Dedeepiya, et al; 2012).

 

Guarente  (2005) defined healthy ageing as the act of using  optimal opportunities properly for health participation and security so as to improve the quality and standard of life of individual as they become older, allowing people to understand their potential for physical, social and well-being throughout the life – course. Healthy ageing has a strong relationship with genetic, environmental and behavioral factors, also with environmental and socio-economic factors. Most of these factors may be regulated by the individual and are known as life style factors and other factors which are outside the individual’s control. However, to improve the life expectancy, a decline in physical function becomes more prevalent. Half of people that are 65 years old and above, have one or more health condition including cognitive, impairment, falls, incontinence, low mass index, dizziness and vision impairment. In any case, failure to detect early signs of malnutrition at early stage will jeopardize healthy ageing, while unnecessary supplementation can mask deficiencies and lead to irreversible damage (Agarwal, 2011).

 

Healthy ageing means finding new things, acquiring and able to adapt to changes, being physically and socially active and feeling the influenced of your community and loved ones, although healthy ageing is much more than staying physically healthy, it’s about maintaining of purpose and your interest for life (Godson and Kemnitz, 2001). According to Wilner, et al; (2010) healthy ageing is that activities and behaviours individual undertake assist to decrease the chances of illness and disease, at the time increase physical, emotional and mental health. Roughly, ten thousand people worldwide die each day of age related cause (Vincent, 2005).

 

It is a known fact that a disease is particularly abnormal condition, a malfunction of structure or function that affects part or the entire organism. Disease is constructed as a medical condition known to appear with particular symptoms and signs (Johnson, 2002). The term disease broadly refers to situation that can impair the normal function of the body, thus diseases are associated with dysfunction of the body’s normal homeostatic process, (Alexander, 2011). Diseases are usually accompanied with any situation that associates with pain, dysfunction, distress and a social problem, which includes; injures, disabilities, disorders, syndrome and infection. Diseases do not only cause physical disturbance on people but emotionally because having a life with a disease can affect one’s perspective of life, as well one’s personality may also be affected, (Kelley, et al; 2003). Tagging healthy to a person with disease can be indication of over treatment, things like taking drugs that assists individuals with severe disease or engaging in adequate management pattern, like encouraging the person to partake in  physical exercise (Lenzer, 2012). Since ageing is a cause or major risk factor of the age related disease and many other causes of mortality, there are growing efforts in ageing to slow ageing and extend healthy life span. (Shmookler, et al; 2009).One of these efforts is good dietary habits.

 

Dietary habits could be described as the habitual decision an individual or culture makes when making choice of what food to eat. The word dietary often refers to specific intake of nutrition for healthy or weight management reasons. Proper nutrition requires ingestions and absorption of vitamins, minerals and food energy in the form of carbohydrates, proteins and fats. Dietary habits and choices play an important role in the quality of life, health and longevity (Gluffrae and Gieronimo, 2000). Many individuals prefer to select animal source food, just because of their different reasons associated with their health, (Bogen, 2012). In developed countries, affluence helps to control the intake of calorie, that is not constrained and possibly not to make inappropriate food choices. Many authorities have recommended the consumption of less energy-dense foods and drink that does not contain too much sugar, eat plant based food, limited and processed meat by people so as to control and maintain their weight. However, there is no absolute understanding of what a healthy diet is made up of, (Burke, 2007).

 

Diabetes may be termed as a chronic disease which occurs when there is malfunction of the pancreas, that is when insulin produced by the pancreas may not be sufficient, or the body system is unable to use effectively the insulin it produces. Health implication of diabetes that is not controlled is indicated by rise in blood sugar, and if not controlled over times may escalate and bring about the destruction of the body system, it damages the nerves and blood vessels mostly, (Inzitari, 2011, and Anderson, 2000). Diabetes can cause health complication including heart disease, blindness, and kidney failure. In addition to the growing health burden of diabetes, the diabetic community has three choices, to make, prevent diabetes, take better care of people with diabetes and prevent devastating complications (Simsi, 2006). Type 1 diabetes usually is first diagnosed in teenagers and adolescents, although it may surface at any stage in life. In respect to this, it could be said that diabetes is an autoimmune disease that could be traced through genetics, environmental or other factors; this accounts for about 5% of diabetes cases. There is no known way to prevent it. An effective treatment requires the use of insulin (Kravitz, 2005). Statistics shown that Type 2 diabetes accounts for 90% - 95% of diabetes case and is usually associated with older age, obesity and physical inactivity, family history of diabetes or personal history of diabetes (Hussern, 2009).

This condition has brought about negative impact on health and well – being, if undetected at the early stage and not treated in a timely manner. Therefore older people with serious situations and their families play a major role in the management of this disease in their daily life. This is commonly referred to as self-management whereby the person with the disease takes a more dimension to their health outcomes, (Lam, et al; 2011). 

 

Aging can brings about difficulties in managing diabetes. One reason for this is that insulin resistance increases and glucose tolerance decreases with age, but there are other indirect reasons as well (Milne, et al; 2005). As people’s attention declines with age, they may be less concerned with the tasks associated with diabetes management, such as carbohydrate counting, meal planning, and blood glucose monitoring and determining correct insulin doses. To have the quality of life improved as we get older, it is better to improve on the quality of live at an early stage. Unfortunately, good health is not a guarantee that comes with aging; it has to be worked on. If we live longer, we will age, that is a fact of life but we can age and be healthy. Whether we are healthy or not, depends largely on our life style and many other factors, therefore it is important that we start to develop a healthy lifestyle early in our lives to ensure healthy aging in our later years (Sullivan, et al 2007).

 

Good health does not always happen naturally. It is mostly the result of a disciplined way of life involving good eating habits on a continued basis through our normal daily living. Notably the good things that are longed for in life, takes time to achieve. Sticking to a good diet regimen, exercise and proper medical care healthy ageing and longevity is possible. Dietary factors may contribute too many diseases people are suffering today, some of which have been since infancy. These factors are then compounded by changes that naturally occur with the ageing process (Bartali, et al; 2003).

 

In most developing countries, the prevalence of non-communicable disease of which diabetes is one of them has almost exceeded the prevalence of communicable diseases (Nwokediuko and Oli, 2008). Studies indicate that an ageing population, coupled with rapid urbanization is expected to lead to an increasing prevalence of diabetes in Africa (Oghera, et al; 2005). In Nigeria, it accounts for between 3.5% and 15% of medical admission in most health facilities of which Abia State is not an exception. In Abia State, there is scarcity of health resources and un-accessibility of health care services. Routine examination for diabetes, using urine/blood glucose is of paramount interest and should be done in most healthcare facilities in the State (Unachukwu, et al; 2008). Most health care facilities do not have basic and appropriate technology for screening, diagnosis and monitoring of diabetes. More often, majority of diabetic peoples present late and often with age related complications.

 Majority of Abians lives in remote villages with limited resources, being mainly farmers, hunters, and petty traders among other activities. Abject poverty is prevalent where diets that are balanced are unavailable. The major type of food consumed is mainly carbohydrate with little or no protein, milk, vegetable and fruits. Due to lack of knowledge, poverty and poor health services, diabetes and other types of diseases are rampant in Abia communities. In Abia State of Nigeria, large numbers of people leave Rural community in search of improved quality of life in Urban areas like Umuahia, Ohafia among others. As a result of these sweeping changes have occurred in people diet and lifestyle modes of physical activity have dropped sharply with increased consumption of calorie-dense fast foods and sugary sweetened drinks.  This work is therefore, aimed at identifying dietary factors that contribute to healthy ageing among diabetic patients with the view of evolving strategies that will bring about improvement in their patterns of dietary practices for the diabetic patients in Abia State.

 

1.2       STATEMENT OF THE PROBLEM

Global demographic report of the World Health organization on health of ageing diabetic patients shows a high morbidity rate. The high morbidity rate of diabetic patients in the developing countries like Nigeria in general and Abia state in particular is a cause for concern (Blas, 2012).

Apparently, there seem to be some common factors that contribute to the condition affecting the health of the diabetic patients. The adverse effects of smoking, alcohol, carbohydrate, poor nutrition, poverty and poor physical condition (the latter due to lack of exercise or the damaging effects of excessively arduous physical labour) have been repeatedly identified as causes of the major health problems in Abia State in general and specific localities and communities.  There is an urgent need to provide more information to diabetic patients about abnormal ageing and about primary health care and self care approaches to problems that do arise (Adorno, 2003).

 

The demographic transition which refers to the transition from high birth and death rates to low birth and death rates leads to increase in the aging population. Most developed countries have completed the demographic transition and have low birth rates while most of developing countries like Nigeria are in the process of transition leading to increased number of old people with ageing problems like increase in diabetes and hypertension. These aging problems are very big in low resource country like Nigeria.

 

The epidemiological transition accounts for the replacement of infectious diseases by chronic diseases like diabetes due to expanded public health and sanitation (Mauck, et al; 2013). There is now a shift from communicable diseases to non- communicable diseases like diabetes and hypertension. Nigeria is still in-between the transition, in which there is both communicable and increase in non-communicable. This is a very big problem in such a resource limited country, trying to combat both diseases. Therefore, this study intends to find out the dietary practices that contribute to healthy ageing among diabetic patients.

 

The American Dietetic Association advocates that the public should consume adequate amounts of dietary fiber from a variety of plant foods (Marlet, 2012). The recommended in take of 20-25 grams per day for healthy adults is not usually met because of low intake of fruits, vegetables, whole and high fiber reduces blood glucose and insulin level. A diet adequate in fiber containing foods usually has fewer calories, fat and refined sugar and is also usually rich in micro nutrients and non-nutritive ingredients that have additional health benefits.

Fiber rich meal is processed more slowly in the gastro intestinal tract, thus promoting satiety. These salubrious features of a high fiber diet promote the treatment and prevention of diabetes, (Templeton, 2001). Diabetes requires complex management in a variety of ways and food insecurity in the state of being without reliable access to a sufficient quantity of affordable nutritious food. A specific and very complex diet is needed to manage diabetes, although with it is increasing prevalence and high cost of treatment, diabetes places an enormous demand on economic resources of the country. The high cost associated with diabetes suggests that reducing incidence through prevention might lower life time medical spending and alleviate some of the future economic burden of treating diabetes. In many cases chronic disease prevention has been found to be cost effective but not cost saving. While prevention averts cost from treating the disease, it may also extend life expectancy and thus could result in more years of health care spending and possibly in greater life time medical spending. Considering the shortened life expectancy seen with diabetes, it is unknown whether life time medical cost for people with diabetes exceeds those of other wise similar people with diabetes.

Difficulty affording food, cost-related medication under use, poor diabetes control, however difficulties in maintaining the more costly lifestyle required to combat diabetes affects patients globally regardless of health care and social services, people with diabetes are at risk for long- term problems which can affect the eyes, kidney, heart, brain, feet and nerves. The best way to prevent or delay these problems is to control your blood sugar and to take good care of yourself.

 

In the National health and nutrition examination survey, the socio economic status, as measured by education and income was not associated with whether or not individuals are likely to have undiagnosed diabetes. This finding suggests that screening   for diabetes should focus on those adults who are at risk of diabetes based on ethnic groups and other clinical risks factors (Wilder, 2005).

There is paucity of literature on healthy ageing among diabetic patients especially in Abia State. Therefore, it is also of utmost importance to find out dietary factors that contribute to healthy ageing among diabetic patients in Abia State.

 

1.3       PURPOSE/OBJECTIVES OF THE STUDY

The major purpose of the study is to determine the dietary practices that contribute to healthy ageing among diabetic patients in Abia State. Specifically, the objectives of the study are stated as followings;

  1. To identify the types of meals that is mostly consumed by diabetic patients in Abia State.
  2. To determine the reasons for choice of meal among  diabetic patients
  1. To determine the major problem of diabetic patients in Abia State.
  2. To determine ways of improving the dietary pattern of diabetic patients in Abia State.

 

1.4       RESEARCH QUESTIONS

The study sought answers to the following research questions.

  1. What types of meals do the diabetic patients consume?
  2. What are the reasons for the choice of meal the diabetic patients take?
  3. What are the   problems of diabetic patients?
  4. What are the measures that can improve the dietary pattern of the diabetic patients in Abia state?


1.5       HYPOTHESES

The following null hypotheses were tested at 5% level of significance.

H01:  There is no significant difference in the mean responses of young and old diabetic patients on the types of meals consumed. .

H02: There is no significant difference in the mean responses of educated and uneducated diabetic patients on reasons for the choice of meal.

H03: There is no significant difference in the mean responses of male and female diabetic patients on the problems encountered.

 

1.6       SCOPE OF THE STUDY 

This study was limited to the investigation of the dietary practices that contribute to healthy ageing among diabetic patients in Abia State. The diabetic patients were the respondents to the instruments. The geographical location of the study is Abia State, Nigeria. The focus hospitals are Federal Medical Centre, Umuahia and Abia State University Teaching Hospital, Aba. The aspects of research include dietary behaviour that enhances longevity among diabetic patients in Abia State. The content scope will be limited on finding out what negate healthy ageing among diabetic patients and remedies.

 

1.7       SIGNIFICANCE OF THE STUDY

This study will be of benefit to everybody including the diabetic patients, dietician, researchers, health workers, young and old people. For diabetic patients, the findings of the study will be able to provide information on diet for those with type 2 diabetes which usually affect the productivity age range from 45 to 65 years in developing countries like Nigeria and Abia State in particular.

The study will provide information that will reduce the disadvantage individual of sufficient access to the resources to manage the condition such as adequate housing, nutritious food and health care services, (Candib 2007).

 

The result of this study will enable diabetic patients to choose or select right dietary practices as to be healthy at old age and avoid unhealthy practices and stay out of hospital. The diabetic patients involved in the study will be able to gain a lot of knowledge from it. Following a healthy diet is a fundamental aspect of diabetic management, also food can help you control your blood sugar level, but it also can cause them to surge out of control.

 

People with every type of diabetes which are the type1diabetes and type 2 diabetes,  the diet plays large role in each of them which includes that type 1 diabetes which cannot produce insulin and must take  medication, a healthy diet can limit the amount of medication needed and reduce the risk for episodes of excessively high blood sugar. The type 2- diabetes may be managed through diet and exercise without using drugs, choosing the right food and following a meal plan is essential.

 

The government institutions will be informed through the health education given to them by the health workers, by making the information available to the health workers.

The findings of this study will also go a long way in adding knowledge to health workers dealing with aged patients with diabetes, the patients may be newly diagnosed or have diabetes of long duration and long term complication, however the appropriate changes in the setting of diabetes are a critical task in the pursuit of healthy ageing. Diabetes in aging increases the risk of suboptimal nutrition, hospitalizations, nursing home admission that substantially impairs quality of lifestyle. The issues include deceased cognition deficiencies in activities of daily living, functional impairment, decreased health literacy, depression, financial problems and strategies to address these issues should be part of health workers practice.

 

For researchers, the findings of this study will go a long way in adding to or increasing the body of knowledge or literature on the dietary practices that contribute to healthy ageing among diabetic patients in Abia State in particular and Nigeria in general. It will encourage further investigations by researchers in the area of handling the healthy living of ageing diabetic patients. The findings of this study will be published in open access journals so that researchers will reference it and use it.

 

The findings of this study will also help to clear the doubts in the minds of some people who have superstitious belief about diabetes, concerning its causes, curability, social stigma and hope for survival. It could also help the Home Economics teachers to benefit from the media and publications about diabetes during Health Education. Above all, the data derived from this work could also be used in teaching young ones the essence of healthy ageing.

 

1.8       DEFINITION OF TERMS

The following terms were used in this study as defined to facilitate the effective communication of the study;

Rethinopathy: Is any damage to the retina of the eye, which may cause vision impairment.

Neuropathy: Disease or dysfunction of one or more peripheral nerves, typically causing numbness or weakness.

Nephropathy: Is a disease of the kidneys caused by damage to the small blood vessels or to the units in the kidneys that clean the blood.

Ulcer: Occur when stomach acid damages the lining of the digestive tract.

Hypertension: (Also known as High Blood pressure), is a long term medical condition in which the blood pressure in the arteries is persistently elevated.

Glucagon: Is a hormone that is involved in controlling blood sugar (glucose) levels.

Hyperglycemia: Refers to high levels of sugar, glucose, in the blood.

Macrovascular disease: Is a disease of any large (macro) blood vessel in the body.

Microvascular disease: Is heart disease that affects the walls and inner lining of tiny coronary artery blood vessels that branch off from the larger coronary arteries.

 


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  • Anonymous

    2 months ago

    Honestly, the material is top notch and precise. I love the work and I'll recommend project shelve anyday anytime

  • Anonymous

    2 months ago

    Well and quickly delivered

  • Anonymous

    2 months ago

    I am thoroughly impressed with Projectshelve.com! The project material was of outstanding quality, well-researched, and highly detailed. What amazed me most was their instant delivery to both my email and WhatsApp, ensuring I got what I needed immediately. Highly reliable and professional—I'll definitely recommend them to anyone seeking quality project materials!

  • Anonymous

    2 months ago

    Its amazing transacting with Projectshelve. They are sincere, got material delivered within few minutes in my email and whatsApp.

  • TJ

    4 months ago

    ProjectShelve is highly reliable. Got the project delivered instantly after payment. Quality of the work.also excellent. Thank you