Andrew Uloko, professor, is an endocrinologist, a diabetologist, and the president of the Endocrine and Metabolism Society of Nigeria (EMSON), who has been in clinical practice for the past 28 years. He is a lecturer in the Department of Medicine, Bayero University, Kano, and trains postgraduate students and resident doctors at the Aminu Kano Teaching Hospital, Kano. In this interview with REMI FEYISIPO, he speaks about the theme of this year’s World Diabetes Day, ‘Diabetes across life stages’, celebrated on November 14, management and approach to care among other issues. Excerpt:
You major in diabetes treatment and management. Why is diabetes considered a major or popular disease of the endocrine system? What other diseases are associated with the endocrine system, and why should we be concerned about them?
Diabetes mellitus is the most common EDM disease in practice. It is popular because its prevalence continues to rise across the world despite advances in the understanding of the disease, therapeutics and the widespread public enlightenment programmes. Yet, a lot can be achieved in the prevention of diabetes through healthy lifestyles. Sedentary living, unhealthy diets, overweight/obesity, stress and mental illness are some of the drivers making diabetes more common and prevalent than previously known.
Other diseases of concern associated with the endocrine system include thyroid disorders, overweight/obesity/dyslipidaemias, fertility disorders, pituitary/hypothalamic disorders, adrenal gland disorders, disorders of growth and development, puberty-related disorders, menopause/andropause, etc. The scope of endocrine diseases is very wide, cutting across other sub-specialities sometimes (for example, endocrine hypertension, PCOS, etc.). These endocrine diseases should be of concern because they are very often misdiagnosed, can present a challenge to management in terms of the very exorbitant cost of care, lack of adequate competent manpower, and poor infrastructure.
Do you think the majority of Nigerians know about diabetes and its consequences? If this is not the case, whose fault is it — the common people, healthcare professionals, or the government?
The majority of Nigerians do not know about diabetes and its consequences. The fault involves all stakeholders — the populace in their poor health-seeking behaviours, the healthcare professionals in their inability to create enough awareness across all strata of our society, and the government in failing to provide the enabling environment and resources that will promote awareness and health promotion at all levels of care. To amplify diabetes awareness in Nigeria, we need to be deliberate in supporting diabetes education initiatives right from the primary health care (PHC) up to the tertiary care levels. The skewed concentration of diabetes experts in the cities only supports a limited number of people, even though the majority of Nigerians live in rural areas. The long-held belief that diabetes affects only urban dwellers no longer holds water as rural communities now have increasing numbers of people with diabetes. Capacity building and manpower development for healthcare workers may help in great measure. The role of the media in this effort will go a long way in creating the highly needed awareness. Programmes and policies towards providing health education for diabetes and related non-communicable diseases will also be helpful.
At what age is diabetes considered more dangerous in humans —childhood, teenage, adulthood, or old age, how does it affect people of different ages?
Diabetes is dangerous in all age groups if not properly managed in a timely manner. In childhood, diabetes is an important cause of retardation in growth and development. During the teenage years, there may be problems with puberty, poor school performance and school absenteeism. In adulthood, diabetes results in absence from work and loss of man-hours. In old age, heightened risk of complications, frequent
hospitalisation from diabetes-related problems, and poor quality of life are common.
What major symptoms of diabetes most signify the morbidity of the disease?
Major symptoms of diabetes include frequent passage of large volumes of urine, excessive thirst, blurry vision, weight loss, poor wound healing, weak and absent penile erection, loss of libido, premature delivery and stillbirth, and prolonged obstructed labour. Diabetes can also present for the first time with complications like stroke, heart disease, loss of eyesight, kidney failure and loss of protective sensation in the feet.
The best approach to care at the stage of these morbidities is to seek help at a credible health facility with competent healthcare providers knowledgeable in the care of persons with diabetes. Claims of miracle cures commonly shared on social media may be gravely misleading.
New thought advocates believe that prolonged anger, frustration, and other negative emotions cause chronic diseases like diabetes, and that freedom from such emotions and positive and faithful living can cure them. What are your thoughts on this?
Poor mental health and stress are known risk factors for diabetes. Diabetes distress is a condition in which persons living with diabetes are unable to cope with their daily lives as a result of the burden of care for diabetes. There is a substantial reduction in the quality of life. Mental health experts and clinical psychologists play a great role in alleviating these conditions. A positive attitude towards health can also be helpful
The theme of this year’s World Diabetes Day, celebrated on November 14, was ‘Diabetes across life stages. How does this theme resonate with you, especially within the Nigerian context?
In the early 70s, diabetes was said to be rare and not a disease of black Africans. At the time, the prevalence figures of less than 1.0 per cent were quoted. Among those few persons affected, they were mostly adults of relatively “affluent” backgrounds. Today, the picture is different. Our findings show that some 11-12 million Nigerians currently live with diabetes. And these figures cut across all age groups. From the rare findings of neonatal diabetes to the worrisome presentations of childhood diabetes and the alarming findings of Type 2 Diabetes in the young, the epidemic is raging and calls for urgent action. The traditional adult/middle life preponderance of diabetes continues unabated. We now know that diabetes is a disease of all age groups.
What is the cost of treatment and management of diabetes compared to ten years ago and how is the current cost of treatment impacting patients and their caregivers?
The cost of managing diabetes in Nigeria today is astronomically much higher than ten years ago. A pen of insulin glargine sold for N5,000.00 ten years ago now sells for N16,000.00 – N19,500.00. This fourfold rise in the cost of insulin (a life-saving medicine for the treatment of diabetes) is replicated in many other medicines used for the treatment of diabetes, a situation that has substantially contributed to the increased morbidity and mortality. The impact of this prohibitive high cost is myriad strains in family life and well-being, increased prevalence of complications, loss of vital man-hours with attendant negative economic indices, and unacceptable high mortality, among several others.
What is your advice to people living with diabetes, especially those who are struggling to treat or manage the disease?
Diabetes is not a death sentence. It can be prevented and well managed with favourable outcomes, provided the right approach to care is applied early. Adopting a healthy lifestyle, avoidance of quarks, and working closely with certified diabetes experts will help.
You are the president of EMSON; what role does your association play in diabetes management in Nigeria. What kind of support does your association need to assist people living with diabetes and related diseases more?
The Endocrine and Metabolism Society of Nigeria is directly involved in the day-to-day care of persons living with diabetes through standard clinical practice, teaching and training of endocrinologists and diabetologists. At EMSON, we undertake research activities towards improving the care of persons living with diabetes. Barely two months ago, EMSON launched a comprehensive clinical practice guideline for the management of diabetes. This guideline, which bears the latest evidence in the management of diabetes, is carefully designed to address care at the PHC, secondary, and even tertiary care.
We also undertake advocacy for our teaming population of persons with diabetes. At the just concluded 2025 world diabetes day celebration, our members across Nigeria engaged in diabetes screening activities, awareness creation and many media campaigns for the improved care of diabetes.
To be able to assist persons living with diabetes, EMSON needs the support of the government in providing the enabling infrastructure that will support the care of persons living with diabetes. We need many more endocrinologists, diabetes educators, nurses, pharmacists, dietitians, laboratory scientists, physiotherapists, etc., to be trained to improve the care of persons with diabetes. A physical office structure in the Federal Capital Territory will enable us to coordinate and execute all our noble initiatives in supporting diabetes care in Nigeria.
If you were the Minister of Health, what would you do to ensure that diabetes management is accessible, especially to those in rural areas?
To promote access to standard diabetes management, I will ensure the upgrading of our PHCs across Nigeria to meet the care needs of people with diabetes. Deployment of trained diabetes experts (motivated by higher incentives) to cover rural and underserved communities will be pursued. Removal of tariffs/taxes on diabetes medications and consumables, tax relief for local/indigenous diabetes drug manufacturers to encourage local production, collaboration with appropriate regulatory agencies like NAFDAC and MDCN, are some of the ways I will help the care of diabetes in Nigeria as a minister of health.
What is your advice to people living with diabetes, especially those who are struggling to treat or manage the disease?
Diabetes is not a death sentence. It can be prevented and well managed with favourable outcomes, provided the right approach to care is applied early. Adopting a healthy lifestyle, avoidance of quarks, and working closely with certified diabetes experts will help.
What does being a medical doctor mean to you, do you think you would have been happier in another career or job than being a doctor?
Being a medical doctor for many decades means a lot to me. It is a privileged experience enabled by God to tend to the health of people, make my modest contributions to the health development of Nigeria, train generations of medical doctors at both undergraduate and postgraduate/specialist levels and put smiles on the faces of my many patients. It also places a moral and ethical burden of care upon me in a way of being accountable to the authorities and God Almighty. If I have the opportunity to come back to this world for a second time, I would still love to be a medical doctor.
Why did you decide to specialise in Endocrinology?
My early motivation for endocrinology, diabetes, and metabolism (EDM) as a preferred sub-specialisation came from my mentor, Professor Fabian Puepet, who practices and trains clinical endocrinologists with a lot of passion in a uniquely simplified manner. At the time I commenced my sub-specialisation in EDM, there were only a handful of endocrinologists in Nigeria, yet a large proportion of persons with EDM-related illnesses had very limited and non-existent access to standard care. The tough training terrain at the time was a huge discouraging factor for many physicians, unfortunately. I was determined to change these narratives if I completed my training as an endocrinologist. To the glory of God, this noble dream was quickly accomplished, and I have been doing my best towards improving the EDM practice and training landscape in Nigeria and Africa.
Apart from EDM, I have a great interest, training and certification in medical education. As a medical lecturer, a trainer of postgraduate doctors, and an examiner to the National Postgraduate Medical College of Nigeria for many years, my endocrinology career easily complements my interest in medical education. And the two specialisations perfectly blend into each other — I am really enjoying this great but rare privilege.
Tell us about your teaching and consultancy as a medical doctor?
I teach and train undergraduate students in the College of Health Sciences of Bayero University, Kano, as a lecturer of the Department of Medicine. At the Aminu Kano Teaching Hospital, Kano, I teach and train postgraduate students and resident doctors in Medicine. I also supervise various categories of students at both undergraduate and postgraduate levels, as well as conduct research in various aspects of medicine, but with a special focus on EDM and non-communicable diseases. I also undertake community outreach programmes and humanitarian activities.
It is uniquely gratifying to see young undergraduates graduate to become medical doctors, develop themselves into world-class physicians, and make great positive impacts in saving lives. These products, spread all over the world, are now worthy ambassadors, a situation which creates a huge sober moment of
reflection for me and a deep sense of gratitude to Almighty God. I have remained in clinical practice now for the past 28 years, during which time a remarkable experience of the day-to-day care of patients with various ailments has helped to shape my perspectives on life.
