As we approach the home stretch of the century, few would argue that during the past decade there have been dramatic changes in the understanding, treatment, and business of diabetes and its complications. New awareness of the genetics and immunopathology of type 1 diabetes, better comprehension of the cellular mechanisms of insulin resistance, and improved appreciation of the basic mechanisms of both microvascular and macrovascular complications have revolutionized the treatment of diabetes. These advances have resulted in studies that are examining the possibility of preventing both type 1 and type 2 diabetes.

At the same time, health care in the United States has evolved into an entity that would have been unrecognizable a decade ago. We are now all familiar with the American health care alphabet soup of HMOs, MCOs, IPAs, PPOs, and the need for PCPs to be aware of allowed drugs by the P&T committee (or face the wrath of the CEO). This was all much simpler when all we had to worry about were I’s and O’s.

It is clear that diabetes has changed for everyone: researchers, academic and nonacademic clinicians, nonphysician health care providers, and administrators. For those in primary care, staying informed of all the changes is particularly challenging.

For the past five years under the successful leadership of Dr. Alan J. Garber, and before that Dr. Marvin Levin, Clinical Diabetes has been the American Diabetes Association’s main mechanism for informing primary care practitioners of advances in diabetes therapies. Now, a new editorial team attempts to continue carrying out this important responsibility. Our first order of business was to revise the journal’s mission statement so that our primary goal is clear to everyone. As you can see in the new mission statement below, we felt it was important to emphasize that we understand who our audience is.

We are fortunate that our new team of associate editors brings a tremendous wealth of knowledge and experience to our effort. Dr. Steven V. Edelman, from San Diego, recently wrote an important review of troglitizone¹ and is particularly interested in improved treatments for type 2 diabetes. He is also a superb teacher and motivator of both physicians and patients. Dr. William Herman, of Ann Arbor, Mich., has been involved in many diabetes-related activities but is perhaps best known for his work in helping us to understand the economic implications of our treatments. Dr. Claresa Levetan, from Washington, D.C., has particular interests in how specialists and nonspecialists can work best together in managing the difficult problems we all encounter (such as ketoacidosis, inpatient management, and screening strategies for type 2 diabetes).

With this, the first issue of our tenure as the editors of Clinical Diabetes, you will note several changes to the journal. First, we will now publish longer quarterly issues, rather than shorter bimonthly ones. In addition, we have added several new departments, which we trust you will find informative. These include:

•"Case Studies." Members of our editorial board will present illustra- tive actual cases they have seen in their offices or clinics. The cases will be concise and will raise important take-home messages for the care of patients with diabetes. We also invite our readers to send in cases they have seen, either to illustrate a specific point of interest or to ask for advise from our experts about some common problem in practice. If one reader has a need for information on a specific diabetes management issue, it is likely to be something many other clinicians would find helpful and interesting, as well. We do not mind if you would prefer not to have your name published, but we will require your mailing address and telephone number (not for publication) should you submit a case study.
• "The Business of Diabetes." As a chronic disease, diabetes has been and will continue to be greatly affected by changes in health care delivery. We are fortunate to have one of our new editorial board members, Dr. Steven B. Leichter, develop this important department as we try to determine and predict how changes in the economics of health care will affect diabetes care.
• "Diabetes Pipeline." We are in the midst of an explosion of new treatments for diabetes and its complications. In this new department, we will describe some of the more exciting advances that are currently being tested to assist our patients in achieving better diabetes management.
• "The Team Approach." Despite the clear need for multidisciplinary expertise in the treatment of diabetes, we still struggle with the issue of how to optimally include nonphysicians in the management of diabetes.^2,3 In the next four issues, this department will provide a closer look at the roles of diabetes team members.
• "Landmark Studies." We will continue to provide concise reviews of   important research studies that may result in significant changes in your practice patterns.

We will also continue to offer our most popular features, such as:

• Feature articles updating you on major topics related to diabetes and its complications
• Dr. Lawrence Blonde’s "Medical Computing" series, in which he reviews web sites, software, and other electronic resources relevant to the medical management of diabetes
• Selected new and revised Association Position Statements and Consensus Statements, which are also published in the journal Diabetes Care
• The popular "Practical Pointers" department, which provides concise reviews of important clinical topics, as well as patient information hand-out sheets.

We hope Clinical Diabetes will continue to improve and meet the needs of all providers who read it. I encourage you to pass an article you find interesting to a colleague, participate in our "Case Studies" department, or simply let us know how you think we are doing. This is an exciting time for everyone involved in the treatment of diabetes. Hopefully, Clinical Diabetes will facilitate your efforts to provide the best possible care to your patients with diabetes.

Finally, I would like to dedicate this issue to the memory of Dr. Julio Santiago, my first mentor in diabetes, who died suddenly last August. Dr. Santiago helped arrange my introduction to diabetes research at Washington University in St. Louis, Mo., in 1980, just before I started medical school. He guided me through several difficult decisions during medical school and residency and was always one of my greatest supporters and teachers, especially during my fellowship, when I returned to St. Louis in 1987.

In the winter of 1990, the two of us went to a St. Louis Blues hockey game (it was the only place I knew I would have his attention and we wouldn’t be interrupted) where he advised me to accept an opportunity to join the faculty at the University of Washington in Seattle. Eight years later, I am still here.

I owe a great deal to Dr. Santiago, and I deeply miss him. I consider myself fortunate to have had the opportunity to interact so closely with him and be his student. I continue to quote him frequently in my lectures and to use his effective techniques in the management of my patients. We have all lost a great teacher, physician, and friend.

REFERENCES

¹Edelman SV: Troglitazone: a new and unique oral antidiabetic agent for the treatment of type II diabetes and the insulin resistance syndrome. Clinical Diabetes 15:60-65, 1997.

²Skyler JS: Tactics for type 1 diabetes. Endocrinol Metab Clin North Am 26:647-58, 1997.

³Kruger D: Editorial: Our changing health-care environment. Diabetes Spectrum 10:3-4, 1997.