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Professor Michael Adeyemi Olamoyegun is a professor of medicine and endocrinology at Ladoke Akintola University of Technology (LAUTECH), Ogbomoso, and a consultant physician/endocrinologist and diabetologist at LAUTECH Teaching Hospital. In this interview by Kingsley Alumona, he speaks about his work, the Nigerian health sector, among others.
What would you say motivated you to study medicine?
I never thought of studying medicine while in secondary school as I was poor in biology due to my poor drawing skills. My desire then was to be an engineer because I was and still exceptionally good at mathematics. However, my brother whom I was staying with and was also going to sponsor me in school insisted I study medicine or pharmacy, or he would not sponsor my education. Hence, I reluctantly began my preparation to study medicine. Around that time, I did my HSC (A/Level) at the then Federal School of Arts and Science, Victoria Island, Lagos, where I studied a combination of physics, chemistry and biology. This marked the beginning of my interest in studying medicine and my eventual voyage into the medical profession. Although it seemed I was coaxed to study medicine, I later discovered with hindsight that it was God’s plan for me, as I have enjoyed every bit of the profession.
I was among the first set of medical graduates at LAUTECH. The experience at school was not very pleasant as we spent 10 years in school because of accreditation delay. However, I would say that God compensated for that delay with my rapid promotion to becoming a professor within nine years as a lecturer at the university in 2021.
Among all the medical specialties you chose to specialise in endocrinology and diabetology. What do diabetology and endocrinology mean?
My choice of internal medicine as a specialty and endocrinology and diabetology as a sub-specialisation was divinely guided as I never thought of it initially. My initial desire was to be a neurosurgeon. However, my desire to be a physician rather than a surgeon developed during my internships as I observed physicians to be more organised than surgeons. Again, during my initial training as a physician, I had thought to be a cardiologist, but shortly after passing my Part 1 examination and needed to sub-specialise, I prayed and felt God leading me to be an endocrinologist. Since becoming an endocrinologist and diabetologist, I have enjoyed every bit of my time in this area of medicine.
An endocrinologist is a doctor who specialises in the body’s hormones and the glands that produce them. However, diabetes is the most common endocrine-related disorder. More than 60-70 percent of patients a typical endocrinologist manages are patients with diabetes.
Diabetes is a serious disease, yet most people do not know what causes it or how it affects the body. Could you shed light on this?
Diabetes is described as a metabolic disorder that is characterised by elevated blood sugar due to a complete lack of insulin, inadequate insulin production, or ineffective action of insulin. There are different types of diabetes, but the major ones are type 1 diabetes (commonly found in younger age groups), type 2 diabetes (adult-onset) and gestational diabetes (pregnancy-related diabetes).
However, type 2 diabetes constitutes more than 90-95 percent of all types of diabetes. This type of diabetes usually occurs among adults (although increasingly being found among adolescents). The onset of type 2 diabetes is usually insidious meaning, the symptoms may not be so sudden or perceptible. Hence, its diagnosis is usually delayed before patients know that they have diabetes. The diagnosis may be delayed by up to 5-10 years. In fact, many people are diagnosed with diabetes on routine investigation or when complications including foot ulcers, visual impairment, poor erection, kidney disease, stroke or even heart failure have set in. Hence, routine laboratory tests are recommended.
However, some of the symptoms that may be associated with diabetes are weight loss, excessive urination, increased thirst or increased water intake, blurred vision, numbness, delayed wound healing, and tiredness, among other symptoms. Some of the risk factors for the development of type 2 diabetes are family history of diabetes, hypertension, obesity, sedentary lifestyle/physical inactivity. Hence, diabetes can be prevented or its onset delayed by many years if the above-named predispositions can be addressed at the individual, community and national levels.
The number of people with diabetes is increasing rapidly in Nigeria due to urbanisation, westernisation of lifestyle and diet, and increasing age and lack of physical activity. This means, more than eight million adult Nigerians are living with diabetes as I speak — unfortunately, many of these people are not aware of their diabetes status.
If diabetes is not genetically linked or caused, could it be prevented?
As said earlier, type 2 diabetes is a preventable disease if the risk factors for its development can be addressed as optimally as possible. The biggest risk for the development of diabetes is family history. However, this does not automatically translate to one having diabetes because of family history and the absence of a family history of diabetes does not mean one cannot develop diabetes. Other predispositions to its development must be addressed to prevent it. Routine tests to detect the presence of diabetes are recommended one to three times yearly.
Treatments for diabetes are expensive these days and most patients cannot afford it. What is your advice to this category of patients?
One of the consequences of the economic crisis in Nigeria now is the astronomic increase in the cost of drugs. Some of these drugs have increased by more than 400-600 percent. For instance, a vial of insulin that used to be sold for N3000 to N4000 less than two years ago now goes for N18,000 to N21,000. The same goes for oral medications for hypertension, and elevated cholesterol which are commonly found in patients with diabetes. Hence, a patient that would need about N15,000 to N20,000 for his/her medications per month about two years ago now needs more than 100,000 to 150,000 per month. How many patients can afford these?
Hence, most patients with diabetes do not adhere to their medications again. This lack of adherence to drugs is a harbinger of poor blood sugar control resulting in diabetes-related complications and death. Today in Nigeria, diabetes is one the leading causes of kidney failure and an increasing number of patients with diabetes are presenting in the hospital with severe diabetic foot ulcers leading to limb amputation. By the way, Nigeria has one of the highest incidences of diabetes-related foot amputations in the world.
The government is encouraged to subsidise diabetes medications, including insulin as it’s being done in many countries of the world. As more than 80-90 percent of the medications in use to manage diabetes in Nigeria are imported, making the medications duty-free will help bring down the cost. Also, the government through its policies should encourage local pharmaceutical companies to go into the production of these medications and multi-national pharmaceutical companies should as a matter of policy be compelled to establish their industries in Nigeria rather than just importing these medications to Nigeria. The government should also encourage the populace to subscribe to the National Health Insurance Scheme (NHIS) and expand its coverage to include most newer medications used to manage diabetes.
Now, most patients pay out-of-pocket for their health care. This is not the best way to cover the increasing cost of diabetic medications. Research will also help discover drugs that will help manage diabetes from the numerous medicinal plants available in Nigeria. This is very feasible. We have got to look inward for indigenous ways to manage diabetes and other medical conditions.
With over 75 scholarly publications, you have risen to become a professor. How do you see and treat diabetes patients the way ordinary doctors would not?
By God’s grace, I am not just a physician, but also an endocrinologist and diabetologist, epidemiologist, pharmacologist, molecular biologist, and genomics expert. I have had the best training and worked in different levels of health care (public and private, federal and state, and multi-national companies as a physician/endocrinologist and diabetologist). I have had the opportunity to attend conferences and training courses in most continents of the world. I have researched and published on almost all aspects of diabetes from prevalence, classification, management, various complications and use of technology in the management of diabetes.
I have led many diabetes research and founded many diabetes-related initiatives including the mobile-diabetes initiative, which pioneered the use of technology in the management of diabetes in Nigeria. This initiative also includes a virtual diabetes clinic and a diabetes rural outreach programme. I have also researched the use of medicinal plants in the management of diabetes as a pharmacologist. Hence, with all humility, I have had the best training to manage all aspects of diabetes as an expert which non-diabetes experts would find difficult to manage. In Nigeria, there are two endocrinology-related societies: the Association of Clinical Endocrinologists of Nigeria (ACEN) and the Endocrine and Metabolism Society of Nigeria (EMSON). Currently, I am the secretary general of ACEN and the public relations officer of EMSON.
What is the latest research or discovery in diabetes studies and treatment? Do you think that diabetes would soon have a permanent cure?
There are many landmarks, and groundbreaking and innovative research outputs in all aspects of diabetes worldwide. These include newer characterisations of diabetes, especially type 2 diabetes, which is now known not to be a single entity but heterogenous, to newer medications that not only reduce blood sugar levels but reduce diabetes-related mortality, to the use of smart insulin pen, continuous glucose monitoring devices, artificial pancreas, and use of artificial intelligence in the management of diabetes. This list is endless.
As of now, it’s difficult, if not impossible, to talk about a “cure” for diabetes. However, there is a concept called “remission of diabetes” in which some selected few patients may have a remission of their diabetes condition and subsequently not require the use of diabetes medication again. In addition, the field of genomics is exploring some gene editing tools like CRISP Cas9 to remove defective genes in the genome of patients with diabetes. However, the journey to the success of this is still in the future.
You are the founder and coordinator of the South West Diabetes Investigative Research Group (SWeDiG). Tell us about the group.
This is a research group I founded in 2018. The members of the group comprised seven endocrinologists drawn from all the states in the Southwest except Ogun State. It remains the largest diabetes research group in Nigeria. Its aims, among others, are to conduct studies on different aspects of diabetes and its management. One of the findings in our previous study showed that more than 60 percent of Nigerians with diabetes are on complementary alternative medicine, including herbs either alone or being used alongside orthodox medicine. This I think would have increased with the increase in the cost of medications these days.
You are also the founder of mDiabetes Nigeria. What is it about?
I pioneered the use of mobile phones among other technologies in the management of diabetes. As demonstrated in one of my publications, mobile phones are a potent weapon that can help improve diabetes management in Nigeria.
The use of technology can be adopted by various governments (federal and states) as one of the sure ways to expand access to health care even to remote and difficult-to-reach communities. This will also help bridge the shortfall in the number of specialists in the country. Experts are available in the country which the government can use to actualise the use of technology to increase access to diabetes management.
Are you generally happy with Nigeria’s current healthcare system in terms of manpower, tools for work, remuneration, and innovation?
No person would be happy with the current state of the healthcare system in Nigeria. The healthcare system is grossly underfunded and understaffed, with a lack of modern equipment to work with. Medical personnel are grossly underpaid and overworked because of the mass exodus of healthcare practitioners abroad. Many of our hospitals are still managing patients’ data manually rather than using electronic medical records (EMR) which make data retrieval and conducting research much easier and faster.
We need to make data-driven decisions if we are to improve healthcare in Nigeria. Healthcare systems are increasingly leveraging big data to make informed, personalised treatment decision plans. This will be difficult to do with manually managed and generated data as it is done at the moment in Nigeria.
To address this, we need to develop a national electronic diabetes registry. With this, diabetes management in Nigeria will be greatly enhanced as patients would be easily tracked and outcomes easily predicted.
How would advise President Bola Tinubu and the governors on how to fix some of the challenges facing the Nigerian health sector?
The president needs to improve budgetary allocation to health, improve remuneration, and provide modern equipment. The government also needs to make the working environment conducive for workers to work and invest in training, retraining of workers, and research. These should also be replicated by state governments.
The future of healthcare is not just about treating diseases, it is about preventing them and ensuring that access to quality care is available to all. As we continue to innovate and break new ground, the challenges lie in ensuring that these breakthroughs are inclusive, affordable, and scalable across the country.
You have postgraduate degrees in Clinical Pharmacology and Public Health. How do these degrees impact your work as a medical doctor and researcher?
These degrees have helped in a great way in my research journey. My qualifications as a public health physician and an epidemiologist have helped me conduct epidemiological studies in areas of diabetes, hypertension and other cardiovascular diseases. As a pharmacologist, I have conducted research on the usefulness of medicinal plants present in this environment in the management of diabetes. Currently, I am working on the combination of two readily available medicinal plants as a potential complementary alternative medicine in the management of diabetes. However, this research requires financial assistance to execute. Hence, getting grants from the government or other sponsors will assist with the progress of the research.
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