This chapter provides an overview of data and perspectives regarding quality of care in diabetes. The evidence base behind metrics used to assess the quality of diabetes care is reviewed, and the degree to which diabetes care in the United States meets definitions of high-quality care at the levels of the organization and the individual is investigated. Risk factor control has improved over the past two decades, but substantial gaps remain between current treatment recommendations and the quality of care received by persons with diabetes in the United States. Among persons with diagnosed diabetes, the prevalence of calibrated glycosylated hemoglobin (A1c) <7.0% in 1988–1994 was 50.9% compared to 58.8% in 2005–2010. Overall age-standardized blood pressure control has improved over time, with 32.8% of persons with diagnosed diabetes achieving <130/80 mmHg in 1988–1994 compared to 50.5% in 2005–2010. Age-standardized cholesterol control has improved dramatically; 33.2% of persons with diabetes had total cholesterol <200 mg/dL in 1988–1994 compared to 67.0% in 2005–2010. Racial disparities are of particular concern, as substantial differences in the prevalence of A1c <7.0% by racial/ethnic groups remain. In 2005–2010, non-Hispanic blacks (53.9%) and Mexican Americans (47.7%) with diabetes were less likely to have a calibrated A1c <7.0% compared to non-Hispanic whites (61.1%). National data reveal gaps in care related to neuropathy and retinopathy among persons with diabetes, suggesting that many patients are not meeting standard of care recommendations. In 2005–2010, 28.6% of adults with diabetes had not had their feet checked by a health professional within the past year, and 18.8% had never conducted a self-exam on their feet. Receipt of eye care has increased over time, with 63.7% of adults with diabetes reporting having received a dilated eye exam within the past year in 2005–2010 compared to 54.4% in 1988–1994. General clinical recommendations for risk factor management in diabetes, focused on prevention and treatment of microvascular and macrovascular conditions, largely define the emphasis of high-quality care. However, this focus on individual treatment targets has several limitations. One challenge is that cardiovascular risk factor treatment advice and guidelines for patients with diabetes are issued by a wide array of stakeholder groups and recommendations often differ; cooperation across guideline development groups has improved but remains suboptimal. Further, the focus only on the “ABCs” of A1c, blood pressure, and cholesterol for improving diabetes care, particularly when tied to treatment targets, may not be appropriate for all patients. Other measures, such as prevention of diabetes, hypoglycemia, patient satisfaction, quality of life, infections, or recurrent hospitalizations, among others, could be considered. The chapter concludes with a discussion of areas in most need of improvement. Extending quality of care standards to address novel indicators could improve outcomes for individuals and also may help identify system factors that could improve care across the population.