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Robert Rapaport Part 2, Treating Pediatric Diabetes

In part 2 of this Exclusive Interview, Dr. Robert Rapaport talks with Diabetes in Control Publisher Steve Freed during the AACE 2017 convention in Austin, Texas about the complexities of managing diabetes, including in pediatric patients.

Robert Rapaport, MD is Professor of Pediatrics, Chief of the Division of Pediatric Endocrinology and Diabetes and the Emma Elizabeth Sullivan Professor of Pediatric Endocrinology and Diabetes at Icahn School of Medicine at Mount Sinai, New York.

Transcript of this video segment:

Steve:  I would imagine that dealing with a patient who is a teenager, or in their 20s and 30s where you can sit and talk to them about hypoglycemia and things they are doing that can affect their blood sugars.  You are dealing with the child where there is ups and downs, highs and lows. Their activities you can’t control. Foods they eat, you can’t control.  You have a much more difficult task, I would imagine, than an adult type 1, even adult type 2.

Dr. Rapaport:  I never underestimate the complexity of taking care of diabetes.  And the complexity falls mostly to the patient and his/her family.  So, I never underestimate the complexity and occasionally the difficulty in doing that. Multiple issues come into play.  The idea of being “in control,” as I think your program is called, is somewhat misleading because it’s a relative degree of control.  We want our patients and their families to be empowered, to be able to exert as much control as possible. We will be there at the phone call’s notice, at an email or text notice, but we want to empower the patients and their families to be able to take care of their condition. Having said that, there are multiple things that interfere with that, including diet, exercise, psychosocial events, all kinds of other events that are a part of just day-to-day living.  One needs to recognize that and be adaptable and flexible to all of those things to achieve optimal control.

Steve:  How long have you been in practice?

Dr. Rapaport:  About 2 hours. [laughter] More than 30 years.

Steve:  When you started practicing, we only had handful of insulins, we had maybe one oral drug.

Dr. Rapaport:  You mentioned oral drugs.  There is still one oral drug that is approved for pediatrics and that is metformin.  With the advent of more studies, there may be more medications that will be available.  There has been a huge change over the last few years, not [only] in terms of therapy, but also in terms of monitoring.  That is really one of the major advances.  When my teachers started teaching me about diabetes, we talked about doing 24-hour urine tests, and now there is finger-stick testing, now hemoglobin A1cs, other indicators of control, and measuring blood glucose level not just a few times a day, but using a continuous glucose monitor.  Having the monitor talk to another device, like a pump.  And obviously, the next phase is the artificial pancreas about which a lot has been written in the last several years.

Steve:  What are your feelings about the MiniMed 670G that came out just recently when it’s used for children?

Dr. Rapaport:  I think it is a very interesting advance, and probably very hopeful advance.  But, I don’t think there is yet enough of experience with it to be able to tell you.  But, it is a major advance in the field.

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