Cardiovascular disease (CVD) is the major cause of morbidity and mortality in people with dia- betes, and represents up to 80% of premature death in this patient population (1,2). Traditional CVD risk factors in the diabetic population include hypertension, insulin resistance, diabetic dyslipidemia, central obesity, smoking and sed- entary lifestyles, while nontraditional risk fac- tors include low-grade inflammation, oxidative stress, endothelial dysfunction, stimulation of the renin-angiotensin-aldosterone system and the prothrombotic state (increased PAI-1, increased platelet aggregation and increased fibrinogen) (3). Control of CVD risk factors in diabetic patients is quite challenging, costly and burdensome, and is only achieved in a small proportion of the population, particularly among those at the high- est risk of CVD, such as ethnic minorities and those with established CVD and chronic kid- ney disease (CKD), as well as the elderly diabetic patients (4-11). Work by our group and others, including nationally representative samples, indi- cate that control of individual CVD risk factors according to the applicable practice guidelines is achieved in less than a third of the diabetic population (6,7,10) with only 3-7% of the diabetic population simultaneously achieving glycemic, blood pressure and lipid goals (6,7,10). While tight glycemic control with hemoglobin A1c (HbA1c) of 6.5-7% has been recommended in various clinical practice guidelines, and is used as a measure of quality of care and in some instances as a determinant of reimbursement such as with Medicare, 'Pay for Performance' initiatives, evi- dence for CVD protection with this approach is generally lacking, especially with long-standing diabetes, elderly populations and in those with CKD (12,13). Furthermore, accumulating evi-