Christine Wiebe; Eric L. Johnson, MD


July 19, 2017

Christine Wiebe, MA: Hello. I am Christine Wiebe, editorial director of Medscape Diabetes & Endocrinology. I am here today with Dr Eric Johnson, who is a diabetologist in Grand Forks, North Dakota. Eric and I had the opportunity to work together on the first Medscape TV show, Confronting Insulin. We spent a few days together in Grand Forks last year, which was a great experience.

Dr Johnson, tell me a bit about what it was like to film this documentary and what it has been like since then.

Eric L. Johnson, MD: My experience filming the webisodes was quite interesting. I learned a lot; for example, it sometimes takes 45 minutes to set up for a shot that lasts about 45 seconds. I enjoyed the process and our clinic staff enjoyed it—getting it set up, being able to show off our community and our town. It was wonderful.


Ms Wiebe: Moving on to the substance of the show, we talked about how to initiate insulin in patients with type 2 diabetes, and how important it is for both clinicians and the patients who have to start insulin. Do you have any new insights about what we did on the show or any reactions to it?

Dr Johnson: This process begins with the patient, as I believe any clinical encounter does, and a wonderful patient helped us illustrate this experience. A number of people in our region have given me positive feedback on the show. They thought it was a good learning piece for them. They can read it on a piece of paper, but actually watching it come alive with a real patient in a clinic setting was very helpful for many. That is what I have been hearing during the time since we filmed it.

Ms Wiebe: I have seen some comments on the show and also on other content about this topic, and one thing I know is that there is still some resistance among clinicians to the idea that type 2 diabetes is a progressive disease, and that insulin may be inevitable at some point in the course of the disease. Have people talked with you about that?

Dr Johnson: We use this video series to illustrate this fact for people who inquire about our program. I will often give them the link, tell them that registration is free, and they can look at it.

You may recall that I drew a graph showing declining beta cell function, and I still do that for all of our patients; it helps them understand the physiologic process. We also conduct a number of primary care–oriented education events in our region. One of the central themes is the progressive nature of type 2 diabetes.

Ms Wiebe: We both agree that prevention is important—exercise, diet, all of the things a person can do to slow the progression, or for those in the early stages, even prevent diabetes. We are not saying that prevention is not important; we are talking about what happens further down the road.

Dr Johnson: Exactly. The lifestyle components are very important at all stages of the disease. We know that lifestyle may have a bit more impact on returning someone to normal glycemia, or near-normal glycemia, if done in the prediabetes stage or very shortly after diagnosis. But for people who have had diabetes for 5 years or more, beta cell function is almost always on the decline, and using injectable insulin is a reasonable approach.

Ms Wiebe: You have told me that a fair number of people have had type 2 diabetes for a while before they are diagnosed.

Dr Johnson: That is true. We do not know the exact timeline. Some data show that up to 50% or more of beta cells are already on the decline, or nonfunctioning, at the time of diagnosis.[1] We know that the undiagnosed prediabetes stage may be fairly long.

Ms Wiebe: Thank you. It has been nice to catch up with you again. I want to remind everyone that if they have not seen the show, they should. I believe it tells this story quite well.


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