Professor Andrew Uloko, professor of medicine and endocrinology at Bayero University Kano (BUK), is the president of the Endocrine and Metabolism Society of Nigeria (EMSON). He is also the Head of the Department of Medicine at BUK and an honorary consultant endocrinologist with the Aminu Kano Teaching Hospital (AKTH), Kano. In this interview by Kingsley Alumona, he speaks about his work, the current diabetes care and situation in the country, and other related issues.
Tell us about your teaching, medical, and research engagements at Bayero University, Kano.
I work at Bayero University Kano (BUK) as a Professor of Medicine and currently serve as the Head of the Department of Medicine. I also work as an honorary consultant endocrinologist with the Aminu Kano Teaching Hospital (AKTH), Kano. I teach and train undergraduate students in medicine at BUK and postgraduate resident doctors at AKTH towards becoming specialists and consultant physicians, especially in endocrinology, diabetes, and metabolism (EDM).
So far, I have successfully participated in the training and graduation of hundreds of medical doctors (MB, BS) at BUK. I have also successfully trained and graduated over 23 consultant endocrinologists. Several young endocrine fellows and MD candidates are currently training with me.
I undertake research activities in medicine generally, and EDM specifically, with over 100 publications in peer-reviewed journals, monographs, technical reports and textbook chapters. A number of our manuscripts are currently in press. Collaborative research with colleagues from several other disciplines and specialisations is ongoing.
I also engage in numerous community service activities towards enhancing population health. Among many other such community endeavours, I deliver public lectures on topical health issues, especially diabetes-related matters at various fora from time to time.
Among all the specialities in medicine, why did you choose to specialise in endocrinology and diabetology?
Endocrinology and diabetology are uniquely interesting, representing a specialty in medicine with very few experts, yet with a growing population of persons in dire need of standard quality care. The large population of our people remained grossly under-served for these largely preventive non-communicable diseases.
It became a challenge as well as a motivation for me to make my contribution towards improving these debilitating chronic endocrine, metabolic and diabetes-related conditions. These, among other considerations, were some of my early motivations to take up EDM as a specialisation.
A few days ago, on November 14, was World Diabetes Day with the theme ‘Breaking Barriers, Bridging Gaps’. What barriers do Nigerians need to break to reduce the risks of diabetes and enhance its treatment?
The theme for World Diabetes Day 2024 is ‘Diabetes and Well-Being’. Barriers to break include overcoming reluctance to screening for diabetes; access to credible sources of information concerning diabetes; dispelling myths surrounding diabetes; addressing poverty and the excruciatingly high cost of diabetes medications and supplies; and provision of adequate competent and skilled manpower.
The frequent open advertisements on all media platforms with purported claims of a cure for diabetes need to be curtailed if we must reduce the risk of diabetes and enhance its treatment.
In 2022, WHO member states endorsed five global diabetes coverage targets to be achieved by 2030, which, among other things, would ensure that 80 percent of people with diabetes are diagnosed, 80 percent of people with diagnosed diabetes have good control of glycaemia, etc. Do you think all this is achievable in Nigeria before 2030?
Yes, if we set the right machinery in motion towards achieving these set targets. It requires a concerted effort by all stakeholders in the diabetes care chain spanning from the patient (and their families) to the healthcare workers, government, policymakers, and patient support groups. A deliberate effort must be made in prioritising diabetes care in Nigeria. For a disease with potential negative impacts on almost every human organ, the description of diabetes as a multi-systemic disease is quite apt.
The key consideration of access to standard care in diabetes is a basic requirement if all the above global goals endorsed by WHO member states are to be met in Nigeria by 2030. However, the prevailing situation of diabetes care in Nigeria remains a far cry from these WHO set goals.
Given the theme of Diabetes Day, what role can the government ─ federal and state ─ play in bridging the gap in the management and treatment of diabetes?
The government should reduce the prohibitive cost of diabetes medications and supplies, ameliorate the distressingly high poverty rate, provide an enabling work environment to maintain the few existing diabetes specialists, support efforts of professional bodies like the Endocrine and Metabolism Society of Nigeria (EMSON), add all life-saving diabetes medications (especially insulins) to the NHIA list.
Appropriate regulatory frameworks and policies that determine positive outcomes must be pursued vigorously.
You are the president of EMSON. Tell us about the society and how it creates awareness or educates Nigerians on diabetes.
The Endocrine and Metabolism Society of Nigeria (EMSON) is the umbrella body of all endocrinologists, endocrine, and endocrine-related activities in Nigeria. EMSON provides opportunities for teaching, training, research and community service activities to Nigerians at all levels.
We engage in patient advocacy, media engagements, population screening, public enlightenment and publication of research findings towards educating Nigerians on diabetes. During the World Diabetes Day celebrations, all our members from the different zones of Nigeria, undertake free public lectures on diabetes, screening of at-risk individuals, and advocacy to the authorities on behalf of our teaming population of patients.
Statistics show that over eight million Nigerian adults are living with diabetes, with significant undiagnosed cases. How do you medical professionals come about these numbers and what can be done to reduce this saddening number of diabetes cases in the country?
The estimated prevalence of diabetes in Nigeria is 5.77 percent (over 12.6 million) of Nigerians currently living with diabetes, using a Nigerian population of 220,000,000. These data were derived from a systematic review and meta-analysis of existing population-based screening activities. A comprehensive national survey, if properly carried out, will give a more accurate prevalence figure.
Unfortunately, the only national non-communicable diseases survey conducted in the year 1992 is too obsolete for reckoning in contemporary times. It is hoped that the Nigerian Federal Ministry of Health will do the needful.
To reduce this alarming figure, emphasis should be placed on disease prevention, creating awareness, population screening, and standard care of persons living with diabetes.
Again, data shows that Nigeria has the highest number of diabetes-related amputations in the world. How does this make you feel? Does this mean that diabetologists in the country and EMSON are not helping enough to manage and treat diabetes patients?
It feels terrible to know about our unacceptably high rate of amputation from diabetes.
The problems contributing to these high amputation rates are multiple, ranging from poverty, poor awareness about the nature of diabetes, poor access to standard care, myths and false religious beliefs, outrageously expensive cost of diabetes medications and consumables, grossly inadequate number of endocrinologists in Nigeria, health inequities on the part of the government in favour of communicable diseases, absence of novel diabetes medications on the NHIA, and the Nigerian Essential Medicines list, etc.
Diabetologists and EMSON are continually doing their best, but need total support from government and well-meaning individuals.
The cost of diabetes management and treatment is on the high side, and most patients cannot afford it. What other better alternatives can you recommend that will help such financially challenged patients?
The government needs to remove tariffs and taxes on all diabetes medications and consumables, return and properly manage the sugar tax on sugar-sweetened beverages, adopt a Nigerian National Diabetes Prevention Programme facilitated by key stakeholders like EMSON, improve access to care at all levels, improve the working conditions of the very few endocrinologists that are still working in Nigeria.
Sadly, many trained endocrinologists have left the country in search of a better quality of life for themselves and their families.
Some new thought advocates believe that disease exists as a result of negative and disease-based thoughts in the mind and that once a sick person believes that disease does not exist and only consistently thinks of life and health, and eats well, they will be healed. If a diabetic patient thinks and feels this way, do you think they would be cured of the disease?
No. Adequate health education is important in dispelling such myths, half-truths, and non-truths concerning diabetes. Diabetes, being a lifestyle disease, can be reasonably prevented by a healthy lifestyle of good physical activity, a healthy diet, and periodic medical evaluation. The activities of faith-based bodies in the care of diabetes can go a long way.
Most people, including doctors, believe that there is no cure for diabetes. But we know that with creative, positive minds, diseases we thought would never have a cure finally had one. So, do you believe that you and your colleagues at EMSON — given available resources and manpower — can discover a permanent cure for diabetes? Do you believe you can take up and execute this task?
Yes, we can. We can do so much towards a cure for diabetes if appropriately supported. Already, research about the high possibility of diabetes reversal is gaining ground and it is hoped we are getting closer. But much is required to support EMSON in delivering on these expectations. With the appropriate support, EMSON can get a lot done in terms of research for a diabetes cure.
Given the theme of Diabetes Day, what is your advice for people living with diabetes in Nigeria?
Diabetes is not a death sentence. Efforts towards prevention are important. For those already living with the disease, ensure you adopt a healthy lifestyle, a positive mindset, prevent complications, access health information and care from credible sources, and keep in touch with your endocrinologist as much as possible.
Family members are encouraged to support any of their loved ones who develop diabetes. Your mental health and well-being while living with diabetes should receive attention where and when necessary, knowing the high risk of developing diabetes distress. All persons living with diabetes are also encouraged to join the advocacy in making the government do the needful for diabetes care in Nigeria.
The fight to kick out diabetes in Nigeria is a genuine fight that must be won.
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