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Reflections

The first 20% of the full text of this article appears below.

Looking into a mirror can be dangerous. On one hand, if the mirror is pointed straight ahead, the reflection could be an image that has gone through many changes. On the other hand, if the mirror is pointed at an angle, one can see images to the side or behind. It is with this in mind that we now turn toward our mirror at Clinical Diabetes.

This will be the last issue of the current editorial team. The 5-year term we complete here has coincided with what has probably been the most spectacular time in diabetes care since the discovery of insulin more than 80 years ago. In this issue, Dr. Arthur Krosnick provides an excellent rearview-mirror perspective on the history of diabetes care by chronicling his 47-year career as an endocrinologist (p. 173). Dr. Krosnick’s article captures the essence of advances through the past five decades of diabetes treatment.

In the more recent past, much excitement in the field of diabetes during our editorial tenure has centered on new treatments. When this editorial team first met in the summer of 1997, insulin lispro (Humalog) had been released a year earlier, and it was already clear that this first insulin analog was a tremendous advance in insulin therapy. At that time, we were also writing our first prescriptions for thiazolidinediones, a new class of oral agents for the treatment of type 2 diabetes. Troglitazone (Rezulin) had just been approved for sale in the United States, and we were all excited about the potential role of this new insulin sensitizer.

Over time, of course, our enthusiasm waned as the first cases of severe hepatotoxicity were reported in 1998. Liver failure resulting in death or the need for liver transplantation made most of us much more cautious about troglitazone. . . . [Full Text of this Article]

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