IIa A to reduce microvascular complications, B to reduce macrovascular complications More stringent HbA1c goals (eg, <6.5%), if can be achieved without significant hypoglycemia or other adverse effects of treatment, might be considered for patients with a short duration of diabetes mellitus, a long life expectancy, and no significant CVD. IIb C 13 Less stringent HbA1c goals (eg, <8%) may be reasonable for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, and extensive comorbid conditions and those with long-standing diabetes mellitus in whom the general goal is difficult to attain despite diabetes mellitus self-management education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents, including insulin. COR indicates Class of Recommendation; CVD, cardiovascular disease; HbA1c, hemoglobin A1c; HF, heart failure; and LOE, Level of Evidence. Management of Comorbidities in Chronic Heart Failure CLINICAL STATEMENTS AND GUIDELINES outcomes during the randomized portion of the trials. However, long-term follow-up of the DCCT and UKPDS cohorts suggests that treat- ment to A1c targets below or near 7% in the years soon after the diagnosis of diabetes is associated with long-term reduction in risk of macrovascular disease. Until more evidence becomes available, the general goal of <7% appears reasonable. ADA, B-level recommen- dation; ACC/AHA, Class IIb recommendation (Level of Evidence A). For some patients, individualized glycemic tar- gets other than the above general goal may be appropriate: a. Subgroup analyses of clinical trials such as the DCCT and UKPDS and the micro- vascular evidence from the ADVANCE trial suggest a small but incremental benefit in microvascular outcomes with A1c values closer to normal. 