After decades of few pharmaceutical options, the past five years have added sorely needed tools to the toolbox for clinicians treating children with type 2 diabetes.

“We have known for a while, with the results from the TODAY study and the Resilient Infrastructure + Secure Energy (RISE) Consortium, that metformin is not a durable treatment option. It doesn’t preserve beta cell function, and it doesn’t prevent insulin use,” said Megan Oberle Bensignor, MD, MSHP, Assistant Professor in the Division of Pediatric Endocrinology at the University of Minnesota. “Now, we have three glucagon-like peptide-1 (GLP-1) receptor agonists and two sodium-glucose cotransporter-2 (SGLT2) inhibitors to consider.”

Dr. Bensignor and colleagues will cover the use of these new drugs and other new developments in the symposium, Everything You Want to Know about the Latest Advances in Pediatric Type 2 Diabetes, on Saturday, June 21, from 4:30–6:00 p.m., in Room W184 A–D of the McCormick Place Convention Center. On-demand access to recorded presentations will be available to registered participants following the conclusion of the 85^th Scientific Sessions, from June 25–August 25.

Among the available pharmaceutical options, there is much to learn about which are the most effective options and their optimal order of use when the A1C-lowering effect is insufficient.

“Is it better to add medications or switch them out? We have made much progress in terms of options, but there is a lot we do not know,” Dr. Bensignor said. “Most of us are looking for a durable, long-term effect, and we do not have enough data to indicate that this is the case with these medications that are indicated for pediatric type 2 diabetes.”

The next step in the field is to look at what is going on under the surface and determine whether beta cells are being preserved or are becoming functional, she said, adding that there is not yet a lot of long-term data to guide clinical decision-making.

There is a lot of eagerness on the part of practitioners to use the single GLP-1 and dual glucose-dependent insulinotropic polypeptides (GIP)/GLP-1 receptor agonists in children, said Tamara S. Hannon, MD, Professor of Pediatrics, Professor of Medical & Molecular Genetics, and Director of the Clinical Diabetes Program at the Indiana University School of Medicine. She also emphasized the existing gaps in knowledge due to the lack of long-term data.

“In the randomized trials for this class of drugs, short-term use was associated with weight gain fairly quickly after the drug was stopped,” she said. “The benefits are seen with long-term use of the drugs, but we know in the U.S., patients’ access has been difficult and not continuous. That’s problematic because the science would indicate that you can’t treat a child for several months or even a year and expect them to maintain that weight loss.”

Dr. Hannon said that the drugs are associated with cognitive effects like decreasing the amount of pleasure reward patients feel from food. Although decreasing pleasure is a positive in the setting of obesity or as a treatment for a gambling addiction, if patients feel less pleasure in life generally, the side effects will be more depressive symptoms, she noted.

“Type 2 diabetes is a bad disease that is worse with childhood or adolescent onset, and these drugs really have shown a great deal of efficacy for reducing A1C,” Dr. Hannon said. “That is a great thing. However, we need to study their full impact on whole-body health in kids. If it turns out that they can delay or prevent microvascular and macrovascular complications, it would be very good news.”

The existing data on long-term follow-up of youth-onset type 2 diabetes shows that the comorbidities of the disease are significant, costly, and decrease quality of life.

“These medicines offer an opportunity for us to have a tool that can really make an impact, which is why there is so much enthusiasm about them,” Dr. Hannon explained.

The symposium also will feature presentations by Fida Bacha, MD, FAAP, Professor at Baylor College of Medicine, and Esra Tasali, MD, Professor and Director of the UChicago Sleep Center at the University of Chicago. Dr. Bacha will discuss cardiovascular disease and nephropathy in youth with obesity and type 2 diabetes. Dr. Tasali will address how to improve sleep in young adults and children to reduce diabetes and obesity risk.