sulfonylurea gliclazide (modified release) and other drugs used as required.576 After a median 5 years of follow-up, HbA1c averaged 6.5% in the intensive-control group and 7.3% in the standard-control group. Intensive control reduced the incidence of microvascular events but had no effect on a composite of macrovascular events that included nonfatal MI, nonfatal stroke, or death from cardiovascular causes.576 In the ACCORD study, patients were assigned to receive intensive therapy with a goal of normalizing the HbA1c (to ,6%) or standard therapy targeting a level of 7.0% to 7.9%.600 Median achieved HbA1c levels at 1 year were 6.4% and 7.5% in the 2 groups, respectively. Over 3.5 years, the use of intensive therapy did not significantly reduce major cardiovascular events (nonfatal MI, nonfatal stroke, and death from cardio- vascular causes) but was associated with a 22% greater all-cause mortality.578,600 The VADT (Veterans Affairs Dia- betes Trial) examined macrovascular complications in pa- tients randomized to standard glycemic control or to intensive therapy (goal HbA1c of ,6%), with a planned HbA1c separation of $1.5%.578 Median HbA1c levels were 8.4% and 6.9% in the standard- and intensive-therapy groups, respectively. There were no differences in the primary end- point of time to occurrence of a cardiovascular event or all-cause mortality in the 2 groups over a median follow-up of 5.6 years. In summary, the most appropriate goal level for HbA1c in patients with diabetes mellitus has not been established definitively by clinical trials. A goal HbA1c ,7% a level approximating that achieved in the intensive-therapy arms of the DCCT, UKPDS, and PROactive studies is reasonable for many younger patients, depending on their duration of diabetes mellitus, comorbidities, adherence, and personal preferences. 