A new paper argues that hypoglycemia should be used as a "counterbalance measure of quality" to fully optimize tight glycemic control in people with diabetes. Researchers from the Mayo Clinic argue that although tight glycemic control can increase the risk of severe hypoglycemia, many perceive the effect as an "unavoidable burden" that should be faced on the path to long-term glycemic control. But severe hypoglycemia comes with a range of adverse outcomes, and the uncertainty surrounding the success of tight glycemic control is causing some patients to question whether the treatment is worth it if it increases hypoglycemia risk. The researchers suggest developing a hypoglycemia quality measure, reflecting processes or outcomes important to patients. Hypoglycemia, they say, can be used as a useful measurement of quality because it is both common and can be prevented by increasing the awareness of patients and clinicians. It is also measurable through blood sugar levels and patient-reported symptoms. Developing these measures could improve the quality of care for millions of patients with diabetes.