The Last of the 9th

To continue with the same theme as last year’s editorial, “7th Inning Stretch” (1), this is the last of the 9th for this editorial team. Although our term doesn’t end officially until the end of 2006, beginning in July, the new team takes over on the new manuscripts and we simply finish up on the ones already under our jurisdiction. So, what is the current status of the journal and what happened during the past year that will impact the new team as well as our authors, reviewers, and readers?

Diabetes Care continues its preeminence in the field of clinical diabetes. One measure of the effect of a journal is its impact factor, the frequency with which the “average” article in a journal has been cited in a particular year. It is calculated as the number of current citations of articles published in the journal during the previous 2 years divided by the number of articles published in the journal during that period. The impact factor for Diabetes Care was 5.0 in 2000, 5.5 in 2002, and 7.5 in 2003 and was maintained at 7.1 in 2004, the last year for which the impact factor could be calculated. This places us 6th among all of the journals in the category of Endocrinology and Metabolism. Since many of the journals above us are review journals, Diabetes Care has moved up to the 2nd most frequently cited journal of original research in this category, being surpassed only by our sister journal Diabetes.

Of most importance, however, to the new Editor and Associate Editors, is the continued growth of Diabetes Care. We have 15,303 paid subscriptions, and during the 12 months prior to 30 September 2005, the Diabetes Care web site averaged 1.5 million “hits” per month. Although at the time of writing this editorial, data are available for the first 9 months only, assuming that the rates of submission remain steady during the last quarter of 2005, there has been a 23% increase in the number of original articles submitted compared with 2004 and a 16% increase if all submissions (original articles, brief reports, reviews, commentaries, point-counterpoints, and letters) are considered. This represents a 120% increase (in all categories) since the current editorial team assumed responsibility for the journal. I still marvel how the same two people, Lyn Reynolds, the Manager of the Editorial Office, and her assistant, Shannon Potts, have been able meet this challenge with only intermittent part-time temporary help. They, and of course the Associate Editors and reviewers, have done a superb job of moving manuscripts along. Reviewers are invited within 2–3 days after the Associate Editor receives the manuscript, and the mean time until an initial decision is sent to the authors is 18 days. Our acceptance rate for the first half of the year was 28% (it takes several months after each quarter to calculate the rate for that quarter). Finally, the preponderance of manuscripts continues to be submitted from abroad: 70% compared with 30% from the U.S.

Last year (1), I introduced a potential National Institutes of Health (NIH) open-access policy for scholarly reporting. Since then, the NIH formally announced its Policy on Enhancing Public Access to Archived Publications Resulting from NIH-Funded Research. This policy requests authors of papers resulting from research funded by the NIH to deposit an electronic copy of their final accepted manuscript into PubMed Central within 12 months of acceptance for publication, to be made freely accessible to the public as soon as possible. The policy went into effect on 2 May 2005, and the American Diabetes Association’s (ADA’s) instructions to authors concerning this were published in the August issue of Diabetes Care (2).

In the September issue of Diabetes Care (3), the ADA and the European Association for the Study of Diabetes issued a statement challenging the concept of the metabolic syndrome. Among other issues, they raised the question of 1) whether the syndrome conveyed more of a risk than the sum of its individual risks, 2) whether there was a common underlying pathophysiology (which is usually accepted as the basis for a “syndrome”), and 3) whether labeling so many people with the metabolic syndrome is really helpful. They suggested that diabetes and clinical evidence of cardiovascular disease not be included in the criteria. The statement also pointed out the lack of an agreed upon definition for the metabolic syndrome, the obstacle that imposes on its study, and the need for more research. Already the statement has started to engender debate (see Letters to the Editor in this issue of the journal), and Commentaries on both sides of the issue are already being prepared. Until more agreement on the metabolic syndrome is apparent, the Editorial Committee decided to change the name of that section in the journal from Metabolic Syndrome/Insulin Resistance Syndrome/Pre-Diabetes to Cardiovascular and Metabolic Risk (starting in this issue). I should mention that this decision was completely independent of any contact from the ADA.

Reviewers always remain a top priority for journals. In 2004, the last complete year for which data are available, there were 1,185 active reviewers for the journal. Of these, 365 contributed 3 or more reviews, and 15 of them qualified for the Reviewer Rewards Program, the criteria of which are a minimum of 12 reviews, which are returned within 17 days or less on average and score in the upper half in the quality ratings by the Associate Editors handling the manuscripts they are reviewing. In 2004, these top reviewers were David G. Armstrong, DPM, PhD; Zachery Bloomgarden, MD; Edwin D. Bransome, MD; John B. Buse, MD; John Clore, MD; William C. Duckworth, MD; Eli A. Friedman, MD; Steven M. Haffner, MD; William J. Jeffcoate, MD; Nicolas Katsilambros, MD; Harry Keen, MD; Anne Peters, MD; Michael Stern, MD; Aaron I. Vinik, MD; and Bernard Zinman, MD. These much appreciated reviewers are eligible to receive either a free subscription to an ADA journal (beyond the one selected with their membership dues) or a book published by the ADA.

Obtaining the services of knowledgeable reviewers remains a challenge. The fact that in 2003 we had 23 top reviewers in the Reviewer Rewards Program may reflect this problem. Other journals have similar concerns, and in November of 2004, the Annals of Internal Medicine began to offer category 1 continuing medical education (CME) credits to reviewers who meet their deadlines and receive a satisfactory grade from the Associate Editor handling the manuscript. The Publications Policy Committee of the ADA considered this approach to attracting reviewers at its recent meeting. We need to determine whether this would be of interest to many reviewers and also the cost-to-benefit ratio before deciding whether to move forward in this direction. These efforts are in process.

Many of you have probably been following the discussions concerning the need for registration of clinical trials. The New England Journal of Medicine, JAMA, Lancet, the Annals of Internal Medicine, and others have decided to publish only those trials that have been registered and have urged other journals to follow suit (4). The International Committee of Medical Journal Editors (ICMJE) defines a clinical trial as “any research project that prospectively assigns human subjects to intervention or comparison groups to study the cause-and-effect relationship between a medical intervention and a health outcome. Studies designed for other purposes, such as to study pharmacokinetics or major toxicity (e.g., phase 1 trials) would be exempt.” The ADA agrees. The following will be added to the instructions for authors, “As of January 2006, Diabetes Care will consider only registered clinical trials for publication. For definitions and further information, please see the section entitled ‘Obligation to Register Clinical Trials’ found in the ICMJE’s Uniform Requirements for Manuscripts Submitted to Biomedical Journals (http://www.icmje.org/index.html#clin_trials).” However, unlike the requirement of the ICJME, trials will not have to be registered before enrollment begins, although we would encourage this.

For several years, I have been trying to require authors to state more specifically their contributions to the paper being published because of my belief that many do not fulfill reasonable criteria for authorship. Although the Publications Policy Committee of the ADA would not go as far as JAMA, the New England Journal of Medicine, Lancet, and the Annals of Internal Medicine do in requiring disclosure of the specific contributions of each author, they did decide to require that the corresponding author endorse the contributions of each author according to the ICJME’s criteria for authorship. To that end, the following statement will be added to the Copyright/Duality of Interest form for authors. “We attest that each author has made an important scientific contribution to the study and has assisted with the drafting or revising of the manuscript, in accordance with the definition of an author as stated by the International Committee of Medical Journal Editors (http://www.icmje.org/).”

On several occasions during the past year, members of the Editorial Committee have raised the question of possible conflicts of interest for reviewers of particular manuscripts. The Publication Policy Committee agreed to our request that we ascertain that there is no conflict of interest for reviewers on each manuscript reviewed. This will be done simply by providing a box to be checked and a field for briefly describing a duality of interest if necessary.

In closing, I will share with you the best kept secret of journal editors. The major determinant of how well a journal functions is the Associate Editors, who in our case toil in the trenches by handling all of the submitted papers describing original research. Whatever success Diabetes Care has enjoyed is largely attributable to the current Associate Editors, Andrew J. M. Boulton, MD; William T. Cefalu, MD; Antonio Ceriello, MD; Ann M. Coulton, MS, RD; Michael M. Engelgau, MD; Lawrence Fisher, PhD; Vivian Fonseca, MD; Eli Ipp, MD; Lois Jovanovic, MD; Seymour R. Levin, MD; Marian J. Rewers, MD, PhD; Ruth S. Weinstock, MD, PhD; and the Associate Editors who served earlier, William Herman, MD, MPH; Harold E. Lebovitz, MD; Mark F. Peyrot, PhD; Richard R. Rubin, PhD; and James R. Sowers, MD.

This ballgame will have no extra innings. I am very pleased to share with you that Vivian Fonseca, MD, will be taking over as Editor in Chief next year (actually in July, as described at the beginning of this editorial). Vivian will have had 5 years of “toiling in the trenches” and certainly knows the ins and outs of Diabetes Care. I have no qualms whatsoever about handing over the reins to this very capable individual and know that Vivian will do an outstanding job.