Unfortunately, the randomized, controlled clinical trial by Buse and colleagues (15) in this issue, which was designed in concert with and funded by the manufacturer of exenatide, does little to help us understand the relative role of the new drugs and nothing to advance CER. Like many industry-supported and designed trials, the design of this study is safe for the drug under study, the glucagon-like peptide 1 [7-36 amide] receptor agonist exenatide, by virtue of challenging its efficacy only against a placebo control and not using an active comparator (competitor). The investigators combine exenatide, the major effect of which is to stimulate insulin secretion, with insulin, presumably with the intent of positioning exenatide for a new indication to be used with insulin. The study is admirable in that it used a double-blind design and the same protocol for adjusting the insulin dose in both treatment groups. Whether the study could be effectively blind, however, considering the high (probably >50%) prevalence of gastrointestinal side effects with exenatide, is questionable. Moreover, although the higher insulin doses in the placebo group than the exenatide group seem to suggest that the goal-driven insulin algorithm was applied as designed in both groups, one wonders why the basal insulin dose was not adjusted even more aggressively in the placebo group to achieve the target fasting plasma glucose level less than 5.55 mmol/L (<100 mg/dL); the fasting plasma glucose levels achieved were 6.77 mmol/L (122 mg/dL) in the placebo group and 6.27 mmol/L (113 mg/dL) in the exenatide group.