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February 13, 2002

Treatment of Type 2 Diabetes Mellitus in Children—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(6):716. doi:10.1001/jama.287.6.711

In Reply: Dr Jones points out that metformin has received FDA approval for use in children within the last year, and that several other drugs are currently in clinical trials. As we suggested in our review, we do believe that there is an appropriate role for pharmacotherapy in the management of type 2 diabetes in children, but that weight loss, diet, and physical activity are the most important aspects of such management. Although data in children are not available, adults with type 2 diabetes cannot maintain acceptable glycemic control while receiving oral agents over the long term, and generally require increasingly aggressive therapy.1 By contrast, recent findings from the Nurses' Health Study suggest that adherence to a low-risk lifestyle could prevent 91% of type 2 diabetes in adults.2 Research into novel medical therapy for type 2 diabetes in children is certainly warranted. However, we believe that lifestyle modification and weight loss are the only interventions that realistically may be expected to prevent disease progression and avoid complications.