Approximately one-half or more of patients with type 2 diabetes did not obtain an HbA1c level lower than 7% in any further step after metformin treatment failure. The descriptive nature of our analysis does not allow a comparative evaluation. However, previous detailed meta-analyses6 have indicated that all noninsulin antidiabetic drugs have similar effects on HbA1c levels. This also seems consistent with our results, since the wide confidence interval made most drugs fairly similar. It seems unlikely that future studies will improve these percentages substantially, unless therapeutic inertia (the health care provider's failure to increase therapy when the treatment goals are unmet) is bypassed. Most recent RCTs recruited patients with type 2 diabetes with a mean HbA1c level of approximately 8.5%: this may favor a greater absolute HbA1c decrease,7 but is associated with a lower percentage of patients achieving the ADA HbA1c level target of <7%. A recent retrospective study of 48 000 diabetic patients in the real world suggests that an HbA1c value of 7.5% is associated with the lowest death rate and lowest rate for large vessel disease.8One action could be to increase the target in order to have more patients at goal with the best outcomes: our preliminary data indicate that this action would results in approximately two-thirds of patients with type 2 diabetes on intensified insulin regimens achieving the goal of 7.5% for HbA1c, vs approximately 54% (95% CI, 43.5%-64.0%) on the actual target (≤7%). Hopefully, this strategy would not only lead to a cosmetic effect (more patients at goal) but also limit the risk associated with lower targets (<7% or <6.5%). We need more help from those involved in writing guidelines to walk the fine line between searching for a wiser and safer HbA1c goal and minimizing the harms of any treatment.