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In a large pan or skillet over medium-low heat, heat bacon drippings or butter until melted, then add thawed pearl onions to pan.
Season with salt and pepper, then sprinkle sugar over onions and cook, stirring frequently, for 3-5 minutes.
Pour balsamic vinegar and water into pan, then reduce heat to low and cover, cooking for 20-25 minutes, stirring occasionally, until softened and caramelized.
Taste and adjust seasoning, if necessary, then serve hot.