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Point-counterpoint: How effective are diet, drugs in managing prediabetes in children? :

October 9, 2018

Editor's note:The2018 AAP National Conference & Exhibition will take place from Nov. 2-6 in Orlando.

Michael S. Freemark, M.D., and Janet H. Silverstein, M.D., FAAP, have years of experience trying to prevent type 2 diabetes in children and improving the lives of those who develop the condition.

The pair will draw on their experiences as they discuss the management of childhood obesity, prediabetes and diabetes during a point-counterpoint session titled “Prediabetes: Diet vs. Pharmacotherapy (D3114)” from 4-5 p.m. Monday, Nov. 5, in room W304AB of the convention center.

Dr. Freemark’s interest in hormonal control of metabolism led him to research the effects of metformin in children with obesity and a family history of diabetes.

“In 2003, we published a study, which was the first to show that a pharmacologic agent, metformin, was able to reduce body mass index standard deviation score and improve metabolic balance in adolescents with obesity who had insulin resistance but not active diabetes,” said Dr. Freemark, Atkins professor of pediatrics and chief of pediatric endocrinology and diabetes at Duke University Medical Center, Durham, N.C. “So, this was the first demonstration that pharmacotherapy might serve as a useful adjunct to lifestyle intervention in the management of insulin-resistant children with obesity.”

As a fellow in pediatric endocrinology at Duke University in 1977, Dr. Silverstein discovered there was no diabetes clinic. So, she asked the Division Chief if they could start one.

“Since I was the one most interested in diabetes, I was also the main person manning the clinic,” said Dr. Silverstein, professor in the Division of Endocrinology at University of Florida College of Medicine and a member of the AAP Section on Endocrinology. “After graduating and coming to the University of Florida, I began attending the Florida Camp for Children and Youth with Diabetes, and it is at camp that I really learned about diabetes management and the impact it has on youth.”

Dr. Freemark plans to take a three-pronged approach during the point-counterpoint session.

“I’m going to try to present the rationale for considering pharmacotherapy in combination with lifestyle intervention in the management of children with obesity,” he said. “Second, I’m going to discuss those factors that should warrant more aggressive and timely intervention and identify children who are at highest risk and therefore are better candidates for pharmacotherapy, and third talk about selected agents and their potential risks and benefits.”

Dr. Silverstein will discuss recent evidence that shows metformin may not be a magic bullet for preventing diabetes and potential alternatives to medication.  

“I think it is important for pediatricians to come to this session to educate them about what is known and what is unknown about diagnosing and treating so that they can make appropriate decisions when seeing these patients,” she said.

For more coverage of the 2018 AAP National Conference & Exhibition visit and follow @AAPNews on Twitter and Facebook.

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