Diabetes Mellitus—A Call for Papers

For patients with diabetes, and for those who treat or study the disease, the last decade has been one of great progress and promise. Tremendous advances have been made in understanding the pathogenesis of both type 1 and type 2 diabetes. The Diabetes Control and Complications Trial (DCCT), published in 1993¹ and the United Kingdom Prospective Diabetes Study (UKPDS), published in 1998,² provided indisputable evidence that near-normal blood glucose levels are desirable for almost all patients with diabetes.

New therapies for type 2 diabetes have been introduced that enhance insulin release and insulin sensitivity, alter hepatic glucose output, and interfere with intestinal absorption of glucose.³ New routes of insulin delivery, including inhaled and oral insulins, may make therapy more acceptable to patients.⁴ Modifications of the insulin molecule should enhance the ability to control glucose levels while minimizing the risks of hypoglycemia.⁵ Implantable insulin pumps⁶ and islet cell transplants⁷ are promising therapies. In addition, solid evidence now exists that aggressive management of dyslipidemia and hypertension in patients with diabetes prevents cardiovascular and other long-term complications,⁸ and optimal management of diabetes before and after conception can prevent diabetes-related fetal malformations and perinatal mortality.⁹

Despite the great strides that have been made in understanding and managing this disease, serious problems continue to confront patients and physicians. The estimated prevalence of diabetes in the United States was 7.4% in 1995, and is projected to increase to approximately 9% by 2025¹⁰ ; diabetes-related mortality is also increasing.¹⁰ Certain population subgroups have prevalence rates approaching 50%, and this is strongly related to the epidemic of obesity and socioeconomic inequalities that plague our society.¹¹

Distressingly, almost half of patients who have type 2 diabetes are not being diagnosed until complications have already developed,¹² and patients with known diabetes are not being managed optimally, even in the best medical settings.¹³ Diabetes-related retinopathy continues to be the most frequent cause of blindness among adults aged 20 to 74 years,¹⁴ diabetic nephropathy is the most common cause of end-stage renal disease,¹⁵ and diabetes is the major cause of lower extremity amputation.¹⁶ These factors are chief among the reasons that diabetes consumes a disproportionate share of total health care expenditures in the United States.^{17 - 18}

Because diabetes has become such a major public health concern, and in recognition of the importance of increasing understanding about the disease, the editors of THE JOURNAL will devote a theme issue to this topic in May 2002. We invite authors to submit manuscripts reporting original research, systematic reviews, special communications, and commentaries on any topics related to diabetes mellitus. Also welcome are papers addressing ethical issues, economic evaluations, and policy analyses relevant to diabetes mellitus.

Manuscripts received by December 1, 2001, will have the best chance for consideration for publication in the theme issue. Other high-quality submissions may be published in other issues of JAMA or, with the authors' permission, may be referred for consideration by one of the Archives specialty journals. As is our policy, all submissions will be subject to editorial evaluation and peer review, with no guarantee of publication. Please follow the Instructions for Authors when preparing manuscripts for submission.¹⁹

For patients with diabetes, the next decade promises to be one of great discovery and hope, unfortunately counterbalanced by substantial disease-related morbidity and mortality. We welcome your submissions that share research findings, enhance clinical understanding, and describe other aspects of disease prevention or treatment that might someday improve the care for patients with diabetes.