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
“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.