As a family doctor I have seen enough change in prevailing health care recommendations to convince me that good evidence is the essential basis of good medicine.  Call me an evidence-based primary care skeptic, and I won’t disagree.  But good evidence takes a long time, and people suffering with diabetes shouldn’t have to wait for better therapy.  While the prevalence of diabetes grows throughout the world, the treatment methods that we have historically relied upon continue to result in poor control and rates of complications that are far too high to ignore.  Faced with alternatives that provide inadequate results, primary care providers make decisions every day that guide our patients down a path that we hope will prove to be more effective.

I joined the Endocrine Society’s Beta Cell team to help with decisions when I don’t have good evidence, and to make sure that I have access to a full and unbiased source of information about what should drive my advice, and what should not.  The Beta Cell team includes expert insight from basic scientists, clinical trialists, endocrinologists, and primary care physicians to better look down the road to where diabetes treatment is going.  One day we will have better evidence.  But until we can confidently replace what we “think” with what we “know” the best alternative is to involve many experts and to explore the why and how of new therapies.  I applaud the Endocrine Society for not providing another set of guidelines developed behind closed doors by appointed representatives steeped in conflicts of interest.  Instead, as a primary care physician, I welcome this opportunity for open discussion and debate about new therapies as the best way to identify where a consensus exists and where it does not, to discover new ideas, and to explore differing perspectives.