There have been important changes in the management of diabetes during the past 30 years. Despite this, many patients still spend substantial portions of the day with elevated glucose levels, and the incidence of retinopathy is unacceptably high. Although diabetic retinopathy remains a leading cause of severe vision loss, data from the DCCT showing a very low risk of severe vision loss, and similar data from the Joslin Diabetes Center (Lloyd P. Aiello, MD, PhD, oral communication, October 2009), indicate that patients who regularly have eye examinations generally will do well, although many will develop retinopathy requiring treatment. Unequivocally, the better the glycemic control, the lower the risk of retinopathy and nephropathy, and the more controlled hypertension is, the lower the risk. Control of lipid levels is less clear-cut but probably also is beneficial. Despite the strength of the evidence that optimizing metabolic control reduces the complications of diabetes and has long-term benefit for patients and for overall public health by reducing health care costs, the current health care system too often does not adequately manage diabetes and is lacking in properly educating and motivating patients to optimize their metabolic control.