We are in the midst of a global pandemic of diabetes. Despite the increasing burden of the disease, measurements of quality repeatedly show poor adherence to or implementation of current guidelines for diabetes care. This article will provide a brief review of the most significant randomized controlled clinical trials relevant to the current guidelines and then discuss essential treatment goals and the evidence that supports them. Several practical clinical questions related to the implementation of modern diabetes guidelines will be raised and answered. Finally, reasons for the poor quality performance observed will be examined.