The current treatment paradigm of type 2 diabetes is the blood glucose paradigm. Under this paradigm, most of the toxicity of T2D is done by the hyperglycemia. Therefore, it follows that lowering blood glucose will amerliorate the complications even though we are not directly treating the T2D itself (high insulin resistance). The ACCORD study was a test of this glucotoxicity paradigm, and unfortunately, a complete and abject failure. Patients were randomized to tight blood glucose control versus usual control, with the expectation that tight control would show tremendous benefits. Instead, the trial proved there were none.