Thirty years of diabetes care: reflections on the beginning.

The 1970s saw an explosion of clinical research in diabetes. In that decade the following was introduced: highly purified insulin, U-100 insulin, basal-bolus insulin therapy, selfmonitoring of blood glucose, glycosylated hemoglobin measurement, insulin pumps, laser photocoagulation, pancreas transplantation, the concept of specialized diabetes educators, and diabetes management teams. In 1975, the National Commission on Diabetes (1) was convened, and its report led to a marked expansion of National Institutes of Health–supported diabetes research, including the creation of Diabetes Centers. In response to these burgeoning advances, the American Diabetes Association (ADA) questioned whether its existing scientific journal Diabetes was adequately answering the needs of clinical investigators and clinicians caring for patients with diabetes. To study the question, ADA created an ad hoc committee under the chairmanship of T. Franklin Williams. The committee concluded that, indeed, a second journal with a more clinical focus was needed. Several potential plans were considered. In the end, the committee chose to launch a peerreviewed journal focusing on clinical research. Although some thought a review journal might better serve the needs of clinicians, the need for a peer-reviewed journal was felt to be sufficiently high that that plan won out. Nonetheless, some, led by ADA President Donnell Etzwiler, questioned whether there was enough highquality diabetes clinical research to warrant a whole journal. That group wondered whether the focus should be broadened to health care in general, with diabetes as a model. Indeed, the original working name of the journal was to be Diabetes Health Care so that it could include both diabetes and general health care articles. Others, led by President-Elect George Cahill, argued that that was too diffuse and the journal should maintain its diabetes focus. Clinical Diabetes or Diabetes—Clinical were proposed as titles. Both were vetoed by the then Editor of Diabetes, David Kipnis, who feared that either selection would relegate Diabetes to be considered as Diabetes—Basic whether or not it was so named. He wanted research in clinical physiology to still be included in Diabetes and for that journal to not be confined to animal or in vitro studies. Meanwhile, a totally different force—the new discipline of diabetes educators—was emerging. They argued that the new journal should also focus on education. The compromise reached was the name Diabetes Care with “Care” also an acronym for “Clinical and Applied Research and Education.” Thus, the name was chosen and the description “Clinical and Applied Research and Education” has been included on the cover or contents page throughout the 30 years of existence of Diabetes Care. The Williams Ad Hoc Committee asked me to serve as Editor for three reasons: 1) Don Etzwiler had proposed me for this role; 2) the committee selected my plan for Diabetes Care, i.e., that from the beginning there would be a focus on peerreviewed original articles; and 3) no one else wanted the job—most of the leadership of ADA thought that Diabetes Care would fail, and they wanted to stay as far away from anticipated failure as they possibly could. Nonetheless, many distinguished diabetologists, with a little arm twisting, were willing to contribute articles that might be used in the first issues. Indeed, volume 1, number 1, included the first description of truncal neuropathy by Max Ellenberg from New York (2), one of the first studies with long-term results of pancreas transplantation by Harold Rifkin and colleagues from Albert Einstein College of Medicine (3), and the first experiences with self-monitoring of blood glucose (SMBG) in two articles, one by Ted Danowski and colleagues from Pittsburgh (4) and the other within Diabetes Care’s first review article, which was on diabetes and pregnancy, by Dan Mintz, Ron Chez, and me (5). The Danowski and Sunder article also included the first description of basal-bolus therapy. Yet, this seminal article, describing both SMBG and basal-bolus therapy, is rarely cited as such. Unfortunately, Danowski and Sunder’s article was titled “Jet Injection of Insulin During Self-Monitoring of Blood Glucose,” and the focus on jet injection obscured the real essence of the article. Danowski actually wanted to introduce blood glucose monitoring to patients, but automated lancets were not yet available. In an attempt to convince patients to test frequently, he thought that offering a jet spray to deliver insulin would obviate the insulin injections and would be a reasonable trade for testing blood. The jet devices he had could only deliver one type of insulin, so he used an approach that he favored anyway: regular insulin before each meal and bedtime NPH as overnight basal insulin. During the first year of Diabetes Care I also intentionally included an article that might be criticized today as “duplicate” publication. Jean Pirart from Brussels had published in French in Diabète et Métabolisme his 4,400-patient prospective 25year observational study that examined the relationship between diabetes control and complications (6). With permission from both Pirart and the French journal, I commissioned a translator to render an English version and published it in two parts (7). It received much acclaim as a seminal set of observations that might have escaped notice of most of the world if only published in French. Moreover, it helped establish Diabetes Care as a journal that clinicians and clinical investigators wanted to read. And Diabetes Care was indexed in both Index Medicus and Current