Looking back on 50 issues of diaTribe and previewing the next 50

This is the 50^th issue of diaTribe! Fifty is a big number, the kind of milestone that makes me pause. Precisely six years ago, we published the very first issue of diaTribe – 50 issues later, I’m honored to still be working toward the fundamental goals we laid down in the first ever letter from the editor. In December 2006, I explained that the mission of diaTribe was to make everyone smarter about diabetes – to leverage the valuable knowledge we gleaned at Close Concerns everyday to give our readers the information they need to better manage their diabetes (and/or that of their friend or family member) and ultimately, to improve their long-term outcomes. Big words, but that was our goal. That meant, of course, that we would have an opinion – we might rant, we might rave, we might lament or celebrate, but we would always inform and enlighten. I explained that my hope was to reach that exquisite tribe of readers who were knowledgeable about diabetes, who believed in intensive management (today, we would say optimal management), and who were eager to learn more for themselves or a loved one.

One thing that hasn’t changed over these past 50 issues – we still love doing them – is our aim to make everyone smarter about diabetes. In the last six years, we have published 28 learning curves, 32 test drives, 33 diaTribe dialogues, 32 editions of what we’re reading, and 47 conference pearls; from our amazing regular columnists, Gary Scheiner has written 15 editions of think like a pancreas, Kerri Sparling has written 25 installments of sum musings, and Jim Hirsch has written 29 logbooks; and that still leaves over 100 trial watch pieces and over 300 new now next articles!

But a number like 50 feels far more like a point along the way than an endpoint. With that in mind, we asked our brilliant diaTribe advisory board members to lend their expertise on how diabetes care has changed since this publication was founded, and how they expect it to change in the coming years. Most important, we’ve asked them for the very best advice they have for patients. See this month’s diaTribe dialogue to read their fascinating insights.

As we’ve blown past the half century mark, there is still so much that we want to explore. We’ve identified several key areas that we believe are crucial to the future of diabetes care, and over the next few years, we hope to delve into many of these topics. By our 100^th issue in 2017, we want to see

• Much more work on diabetes prevention and aggressive efforts to understand and treat prediabetes;

• Real incentives to eat and drink and exercise optimally;

• Better understanding of the psychological and behavioral aspects underlying diabetes and obesity;

• More widespread use of CGM and insulin delivery devices that are less burdensome and work like “normal” physiology;

• Real progress on the artificial pancreas (i.e., approval for outpatient use of a hybrid artificial pancreas);

• Real progress on a bioartificial pancreas and other type 1 cures, especially vaccines and beta cell replacement;

• The establishment of highly effective, well-researched mobile health solutions that truly help with day-to-day management of diabetes and major strides to toward accessibility;

• Real advancements on medicines that reduce cardiovascular disease;

• Improved diabetes care in primary care settings, which will increasingly become the focus point of diabetes health care;

• Much better reimbursement for the time of healthcare providers;

• A reversal in the disturbing decline in endocrinology and internal medicine specialization among medical school students;

• Better use of, and reimbursement for, certified diabetes educators (CDEs);

• For type 1 patients, real exploration of the potential benefits of GLP-1 agonists, SGLT-2s, and DPP-4s;

• Meaningful advances in glucose responsive insulin;

• Strides toward “treat to normalcy” not “treat to failure” – healthcare providers and patients working toward optimal control for patients, even approaching normalcy for those that can achieve it;

• Payers and insurers as partners in the fight toward making people with diabetes healthier than average and not a drag on our economic system;

• An increasingly robust online diabetes community that engages more people and builds bridges between the type 1 and type 2 communities.

It’s a huge list, and it’s one we look forward to exploring over the coming years – and being around to report on when these hopes and dreams become reality. Whether these come in issue 51, issue 100, or beyond, we at diaTribe sure plan on being there with all of you.

Thank you for all you are doing to improve your health or the health of a loved one. We owe it to everyone to try as hard as we can – and I know we can do it if we all work together. You have inspired me to try even harder as our diaTribe team continues to try to make you smarter by sharing with you all the findings throughout the globe.

very best,

Kelly L. Close