Diabetes and the Oprah Effect

Dr. Fran Cogen Health Pro
  • I must have been one of the last people on the planet to view Oprah Winfrey's much heralded show on Diabetes. Having missed the originally televised episode, I was able to see it when it was replayed in the middle of the night. (I used my DVR.) Since I was completely snowed in on Saturday, Feb 6 ("Snowmaggedden" in the DC area), I sat down and watched the show... or at least as much as I could without getting enraged. So many people have commented with plus and minus remarks on this site and on the Oprah web site.

     

    I wanted to take the opportunity to share my thoughts about the program...and they are not all bad. I must first disclose that 95 percent of my diabetes practice consists of children/teens and young adults with type 1 diabetes. Thus, it does matter to me that clear distinctions are made between type 1 and type 2 diabetes. In defense of Oprah, Dr. Oz did make a few remarks about the difference between type 1 and type 2 diabetes; but by the time he mentioned them, all viewers were so "freaked out" by the graphic depictions of serious long-term complications of diabetes, including dialysis and amputation of limbs, that they probably did not hear the distinctions.

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    Positive Remarks

    1. Let's face it, the show did bring Diabetes to the forefront. People are paying attention--albeit with shock tactics (in my opinion).
    2. Dr. Oz did discuss physiology and how insulin enables glucose to be absorbed into cells. He briefly commented on the difference between lack of insulin in type 1 and insulin resistance of type 2 (more on that later).
    3. After scaring everyone, Oprah and other individuals, including the exercise physiologist and dietician, did give concrete information how to improve diabetes control and inferred that one could go into "remission" if one followed the behavioral suggestions (more on that later).
    4. The patient interviewed at Columbia Presbyterian Medical Center by Dr. Oz did comment that she should have taken better control of her diabetes when she was diagnosed at a young age with Type 1 Diabetes.
    5. The show addressed the fact that the disease is rampant in African American and Latino populations, but diabetes is present in every ethnic background. (There was no mention about the etiology of type 1 Diabetes, more on that later).
    6. Good diet and exercise tips.
    7. The show scared me! I ate very carefully the rest of the day and got on the treadmill (after shoveling all morning) to decrease my risk of getting T2DM.
    8. Shock Value does get people motivated. At least it works more for adults, and it does not always work with teens who believe they are immortal.

     

    Negative Remarks

    1. I do not like to be yelled at by a TV doctor. I am aware that Dr. Oz is a renowned surgeon at Columbia Presbyterian; however, appearing in his scrubs when not in surgery is very dramatic and I do not appreciate it. (This is not "Grey's Anatomy"). I also do not like for people to be made to feel guilty or ashamed of having a disease. I felt that he was, at times, condescending and self-serving with his remarks (just my opinion).
    2. Dr. Oz did make brief distinctions between T1DM and T2DM several times; but not clearly enough for both the studio and television audience to comprehend. I felt that in the end, they were lumped together without enough separation.
    3. People need to change behavior after understanding about their disease and possible consequences. Scare tactics work superficially; but not always in the long run. Certainly for my population of teenagers, scare tactics are not effective. They feel that these complications will never happen to them. After all, 30 is old. Studies have shown that teens do not change their diabetes self-care skills after visiting VA Hospitals in which veterans have lost limbs to diabetes complications.
    4. I was greatly disturbed by the patient at Columbia Presbyterian with type 1 diabetes. It was graphic and I felt like I was invading her privacy. (However, if her interview motivated one person to take better care of his/her diabetes, I suppose it was worth it.)
    5. Diabetes care is a marathon, not a sprint. Everything is not going to be fixed right away. One show is not going to fix everything.
    6. Once you get type 2 diabetes, it does not disappear. One can improve insulin resistance and keep blood sugars stable and go into a remission. Pre-diabetes can be reversed with behavioral modifications. I do not believe that these distinctions were made crystal clear.
    7. Of more value, perhaps, would be several shows depicting the different types of diabetes and care specific to that form.
    8. I was appalled that Wal-Mart pharmacies did diabetes screening with glucose meters. The American Diabetes Association does NOT recommend doing blood glucose screening at health fairs, etc. It suggests that you to go to a qualified health professional that can not only diagnose, but care for you should you have an abnormal blood test. After all, was the blood glucose taken after fasting, postprandial, or after exercise? How does one interpret the results? Who interprets the results?
    9. Most importantly, I felt so hopeless after watching the show. What about my patients who take such good care of themselves by checking blood glucose levels 6 times/day, giving insulin accordingly and following-up with their healthcare team appropriately, while maintaining excellent hb A1c's? Why didn't Dr. Oz mention the DCCT or UKPD study noting decreased complications with intensive insulin therapy?
    10. Oprah now needs to provide follow-up and continued positive educational interventions with her "audience-patients" as all good healthcare teams should.

     

Published On: February 16, 2010