Today’s JAMA commentary points out that current diabetes treatment recommendations should be guided by more than just A1C, as recent studies on glucose lowering medications have shown that some now have impacts on lowering cardiovascular complications that are distinct from their effect on lowering A1C. The last 15 years have produced a number of large prospective randomized clinical trials that have provided important information. The translation of these trials into guidelines have been slow, however. This lag, or gap, is important because guidelines today are more than just guides. They have passed from suggestions to requirements, as payments and clinical rankings are based on conforming to these guidelines. Unfortunately, most guideline committees have not been up to this challenging task. Just as it is hard for individuals to change their mind, it is even harder for guideline committees to modify, let alone reverse previous recommendations. I have to think that this process is made even harder by relationships with pharmaceutical companies, with a large majority of practice guideline physicians reporting ties to pharmaceutical companies, which does not include the substantial percentages with unreported conflicts.