ABSTRACT
While insulin has long been the foundation of treatment in diabetes mellitus, over the past decade exciting modalities have become available in the therapeutic armamentarium. Within the spectrum of insulin options, new insulin analogs offer means to more closely reproduce normal physiologic insulin secretion than ever. The development of insulin pumps with continuous glucose monitoring brings closer the reality of a closed-loop system of glucose homeostasis. Type 2 diabetes mellitus (T2DM) in children and insulin resistance overlying features of type 1 diabetes mellitus (T1DM) are becoming increasingly common (1-4). Thus, the intervention paradigms available to address the pathophysiology of T2DM and insulin resistance, such as insulin sensitizers, are becoming more important in the pediatric diabetes population. New classes of medications, such as the incretins, offer the potential promise of b-cell preservation. Overall, new treatments and technologies enhance the ability to safely and effectively implement intensive treatment regimens. Intensive treatment is crucial to avoid the complications of poorly controlled diabetes mellitus, as clearly demonstrated by findings from the Diabetes Control and Complications Trial (5). This is particularly important as the number of children with diabetes, particularly with onset at very young ages, continues to rise.
