Guiding Principles for Diabetes Care

With the use of editorial commentaries over recent years, our editorial team has provided significant comments and updates at routine intervals regarding our progress as a leading diabetes journal. Many of the editorials were geared to addressing specific areas of science, providing discussion on clinical care or clinical research focus in a particular issue, or informing readers of new initiatives. With this issue of Diabetes Care, we want to provide comment on the process by which we acquire, gain, and put into practice recommendations based on new evidence, or when the evidence is not quite complete, how we make practice decisions based on the best evidence to date from consensus. Specifically, we are referring to the dissemination of recent updates from the American Diabetes Association (ADA) in the form of position statements, scientific statements, and consensus reports (proceedings from ADA Consensus Conferences). It has been a special privilege for our journal to publish these important narratives. In this regard, this issue is particularly noteworthy as two comprehensive narratives (a consensus report and a scientific statement) are included that provide an enhanced focus on the advances in pathophysiology and pathways for development of therapies for type 1 diabetes. In addition, an ADA position statement provides an update on disease management and policy recommendations for students with diabetes in the elementary and secondary school settings. The updates in these particular areas not only provide important clinical information but also complement extremely well the special article collection in Diabetes Care (June 2015) entitled “Type 1 Diabetes at a Crossroads” (1). In that issue, the journal specifically focused on issues pertaining to type 1 diabetes and published articles that commented on the latest update from studies, opinions, and perspectives in the field. The fact that this issue highlights three specific narratives from the ADA is not new or novel. The ADA has been actively involved in the development and dissemination of diabetes care standards, guidelines, and related documents for over 20 years that have regularly appeared in Diabetes Care. ADA position statements, scientific statements, and consensus reports are based on clinical and scientific research, expert opinions, and patient preferences. Generally, most readers are familiar with obtaining updated information from the ADA through the Standards of Medical Care in Diabetes recommendations published each January in Diabetes Care. The development of these Standards is extremely rigorous and based on the guiding principles listed in the Institute of Medicine’s Standards for Developing Trustworthy Clinical Practice Guidelines. In the January 2015 issue, the recommendations were examined and trends in the quality of evidence supporting the recommendations were ranked: higher evidence levels A and B versus lower levels C and E (expert opinion). As we stated in the January 2015 editorial and as outlined in the report, over the 9-year period spanning from 2005 to 2014, the proportion of recommendations from the ADA per year that were based on higher-level evidence increased from 39% to 51% (2,3). With these findings, it was clear that the process for review from the ADA is robust. The Standards recommendations appear to be well known to most readers, but theymay not precisely know the purpose for specific initiatives from the ADA as they appear in the current issue. As a case in point, the ADA position statement is an official ADA point of view or belief that contains clinical or research recommendations. Position statements are issued on scientific or medical issues related to diabetes. The position statement in this issue, “Diabetes Care in the School Setting: A Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA American Diabetes Association, Alexandria, VA