Diabetes Care (ADA) 'Under Review': What Each Status Means

Before the paper reaches Associate Editor assignment, the Diabetes Care Editor-in-Chief assesses each submission via the priority-score gate. About 30 to 40 percent of manuscripts are desk-rejected at this stage within 2 to 3 weeks. A desk rejection most often means the EIC concluded that the work would fit better at a sister ADA journal (Diabetes for basic-translational diabetes, Clinical Diabetes for primary-care diabetes, Diabetes Spectrum for diabetes education) or that the clinical diabetes priority bar is not met.

The Diabetes Care editorial office confirms files are complete: manuscript with figures embedded, supplementary information separate, CONSORT checklist for clinical trials (required), reporting checklists where applicable (STROBE for observational studies, PRISMA for systematic reviews), cover letter directed to the editor, conflict-of-interest declarations, ethics-statement documentation, IRB approvals, trial-registration documentation, and data-availability statement.

The EIC assesses each submission to determine whether the content meets Diabetes Care's clinical diabetes priority threshold. The priority-score gate filters out manuscripts below the 50th percentile.

In parallel with the EIC's priority-score assessment, borderline-score papers are discussed across the ADA editorial team where peer Associate Editors weigh in on whether the paper meets the priority threshold. This editorial-team discussion runs alongside the assessment and adds 3 to 7 days to the timeline that is invisible to the author in the portal.

Papers that pass the priority-score threshold are assigned to an Associate Editor versed in the subject area of the manuscript. The Associate Editor invites 2 to 3 diabetes expert reviewers.

Diabetes Care Associate Editors typically invite 2 to 3 diabetes expert reviewers, with reviewer recruitment typically taking 7 to 14 days. The recruitment window can take longer because reviewers with topic-matched clinical diabetes subspecialty expertise (especially with disparities-awareness focus) are scarce.

Once reviewers agree to review, the typical Diabetes Care peer-review cycle lasts 6 to 12 weeks per reviewer, contributing to the 100 to 130 day first-decision window. Reviewers are asked to evaluate study design, outcome rigor, clinical significance, and disparities awareness. Reviewer reports for Diabetes Care tend to be thorough; 2000 to 4000 word reports are typical.

After reports return, the Associate Editor synthesizes them and recommends a decision to the EIC. Revisions often request additional outcome data or disparities analysis. Publication occurs 2 to 4 weeks after acceptance.

• Return within 1 to 21 days: EIC priority-score return or desk rejection per the 30 to 40 percent figure.

• Still Under Review after 4 weeks: Strong signal. Paper met the priority-score threshold and is in active review.

• Still Under Review after 16 weeks: Reviewer-recruitment or reviewer-report delay. A polite inquiry via the ScholarOne portal is appropriate.

• Status changes to "Decision Pending": Reports are in; expect a decision within 1 to 2 weeks.

This is the most common anxiety we hear from Diabetes Care authors during the active editorial window. The honest answer: no, 10 weeks (~70 days) puts you in the early-to-middle portion of Diabetes Care's 100 to 130 day first-decision window. Reports may still be arriving with the Associate Editor preparing for editorial synthesis. Most reviewer-driven delays come from reviewer-recruitment timing for clinical diabetes subspecialty experts rather than slow reviews.

If the portal still says Under Review at the 16-week mark, the most likely explanation is that one of the assigned reviewers asked for an extension and the Associate Editor granted it. This is normal practice at Diabetes Care.

What you should NOT do during the 10-to-16-week window is email the editorial office. Diabetes Care Associate Editors are working academic clinical diabetes researchers managing 30+ active papers around their own clinical practice; an inquiry at 10 weeks adds friction without accelerating the timeline.

If your Diabetes Care paper is rejected after review, the natural cascade depends on what the reviewers and Associate Editor cited:

Diabetes is the natural ADA cascade for basic-translational diabetes papers where the clinical-application bar of Diabetes Care is not the primary contribution. Diabetes uses ScholarOne at ScholarOne submission portal; editorial contact diabetes@diabetesjournals.org.

Clinical Diabetes is the ADA cascade for primary-care diabetes practice papers.

Diabetes Spectrum is the ADA cascade for diabetes education and management papers.

Diabetes, Obesity, and Cardiometabolic CARE is the new ADA cascade for cardiometabolic-care focused papers.

Diabetologia is the external EASD cascade for European clinical diabetes research.

Journal of Diabetes (Wiley) is the external cascade for general clinical diabetes. Wiley uses Editorial Manager at Editorial Manager submission portal; editorial contact jdiabetes@wiley.com.

The Lancet Diabetes & Endocrinology is the Lancet specialty cascade for top global-impact diabetes/endocrinology. The Lancet uses Editorial Manager at Editorial Manager submission portal; editorial contact editorial@lancet.com.

ADA asks reviewers at Diabetes Care to evaluate four things specifically. The table below maps each to actionable preparation.

Across Diabetes Care-targeted manuscripts, and across Manusights review data from 50+ diabetes, endocrinology, and clinical-medicine manuscripts, three named patterns generate the most consistent reviewer concerns and the most common reasons papers miss the editorial bar or fail the priority-score gate.

Below-50th-percentile clinical priority framing flagged at EIC. When the introduction frames the work too narrowly without broader clinical diabetes priority, EIC priority-score return is common. The strongest Diabetes Care manuscripts make the clinical question visible in the title, abstract, first table, and final introduction paragraph, then connect the cohort, endpoint, and practice implication to the ADA readership rather than relying on a generic "important disease burden" rationale.

Disparities analysis gaps surface as reviewer concerns. When the manuscript does not include disparities analysis in the main outcomes, Diabetes Care reviewers consistently ask for race, ethnicity, socioeconomic status, geography, access, or cost-effectiveness context. The strongest manuscripts do not bury these variables in supplemental tables. They explain missingness, subgroup power, and what can or cannot be inferred from the enrolled population.

ADA family cascade offers from Associate Editor. When the Associate Editor concludes the work is rigorous but the clinical diabetes priority bar of Diabetes Care is not met, transfer offers to Diabetes for basic-translational work, Clinical Diabetes for primary-care practice, or Diabetes Spectrum for education and management are common. Authors should prepare the cover letter and response plan so the manuscript can move cleanly if the reviewer concerns point to a better ADA family fit.

Source limitation: this guidance combines official guidance, public status and timing signals, and anonymized Manusights pre-submission review patterns; it does not use private ADA editorial records. Compared with official guidance, the useful reader-facing value is translating the status into clinical-priority, outcomes-table, statistics, disparities, and ADA routing checks authors can act on while waiting.

This page was created from ADA's public Diabetes Care instructions for authors at Diabetesjournals author instructions, ADA Journal Policies documentation (EIC priority-score gate above 50th percentile, 30 to 40 percent desk rejection rate, 100 to 130 day first-decision window, 2 to 3 diabetes expert reviewers assessing study design / outcome rigor / clinical significance / disparities awareness, publication 2 to 4 weeks after acceptance), and Manusights pre-submission review experience with Diabetes Care-targeted manuscripts.

For the ADA diabetes landscape beyond Diabetes Care, start with the Diabetes Care journal overview, the Diabetes Care submission guide, the Diabetes Care review-time guide, and the Diabetes Care cover-letter guide.

Then compare Diabetes (basic-translational diabetes), Clinical Diabetes (primary-care), Diabetes Spectrum (education), Diabetes, Obesity, and Cardiometabolic CARE (cardiometabolic), and external diabetes alternatives (Diabetologia, Journal of Diabetes, Lancet Diabetes & Endocrinology).

The choice across these titles depends on whether the central contribution is top ADA clinical diabetes (Diabetes Care), basic-translational diabetes (Diabetes), primary-care diabetes (Clinical Diabetes), diabetes education (Diabetes Spectrum), cardiometabolic care (Diabetes, Obesity, and Cardiometabolic CARE), European clinical diabetes (Diabetologia), general diabetes research (Journal of Diabetes), or top global-impact (Lancet Diabetes & Endocrinology).

Reviewers at Diabetes Care typically draw from 2 to 3 clinical diabetes subspecialty experts with disparities-awareness focus. Editors screen and triage manuscripts before any external reviewer sees them via the priority-score gate, and preparing a response template that addresses both clinical-significance and disparities-analysis perspectives accelerates revision rounds substantially.

For a pre-upload check of your manuscript against the Diabetes Care clinical-diabetes-priority-plus-disparities bar before submission, our Diabetes Care pre-submission diagnostic flags the framing and disparities-analysis weaknesses most likely to surface in reviewer reports.

If your manuscript is already in the portal, use the Diabetologia Under Review status guide to interpret the status window, follow-up threshold, and reviewer-risk preparation while you wait.