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The CBC recently reported on a publication by Dr. Victor Montori, of the Mayo Clinic in Circulation: Cardiovascular Quality and Outcomes arguing a lack of evidence glucose-lowering drugs help ward off long-term complications. There is truth is this: but as usual the devil is in the details. There is overwhelming evidence that high blood sugar is the primary cause of diabetic blindness, kidney damage and amputation. The paper correctly points out that below a certain point (say below an A1c level of 7.5, a value chosen by me for the sake of argument) there is little high quality evidence to suggest additional benefit. This does not mean that there isn’t a benefit, it is just that the evidence has not been found. Leading national diabetes organisations including the Canadian Diabetes Association, the American Diabetes Association and the European Association for the Study of Diabetes all have guidelines recommending achievement of “A1c <7.0 where practicable”. At BCDiabetes.ca we believe that achieving an A1c < 7.0 is desirable, but much more important is achieving A1c < 8.0. The sad truth is that hundreds of thousands of Canadians and tens of millions of Americans and Europeans have A1cs much higher than 8.0. A concerted effort needs to be made to help this high-risk group achieve better blood sugar control.