Insulin Glargine Controversy: A Tribute to the Editorial Team at Diabetologia

Abstract

rogress in biomedical research is documented in journals after peer review, a process with flaws but the best we have.Once an article is published, in general it faces three fates.Most commonly, after some measure of initial interest, it quietly slips into obscurity, only occasionally to resurface if cited by a vigilant successor who recognizes the prior contribution to a once again advancing field.A quick glance through a copy of any major medical journal published Ն50 years ago is a humbling experience for any active scientist.Many of the confidently stated conclusions, with hindsight, were quite simply wrong.How many of our conclusions today will seem mildly amusing to a reader 50 years from now? Occasionally, an article makes a tremendously important contribution that advances a field and is widely cited, becoming a so-called citation classic with little controversy.Reading such a paper that is Ն50 years old can also be a humbling experience.How did the authors have such insight from what we now consider an incomplete dataset obtained by insensitive and nonspecific methods compared with those available to us now?It was clear to the editorial team at Diabetologia that an article recently submitted to that journal was one that fell into a third category (1)-an article that is likely to incite immediate controversy.Typically, such an article, once published after peer review, then stands or falls as a result of wider scrutiny by scientific peers.At first sight, it would seem that the early controversy is harmless enough if the authors are willing to stand the heat in the kitchen.However, there is an important exception to this in biomedical research: if the conclusion of the paper might alter clinical practice in such a way that patients can be harmed or contains information that might lead to unnecessary concern for patients if the information reaches the general media.When an article that reported an increased incidence of cancer in people using insulin glargine (1) was submitted to Diabetologia, the editors took extraordinary steps.Not only was the article subject to the usual peer review, but before publishing the study, the editors solicited additional studies from investigators with epidemiological databases from several nations (2,3,4).Is such expediency by editors of a journal typical?I think we have to agree that the answer is no.The resulting studies were then