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. Therefore, for selected individual patients, providers might rea- sonably suggest even lower A1c goals than the general goal of <7% if it can be achieved without significant hypoglycemia or other adverse effects of treatment. Such patients might include those with short duration of diabetes, long life expec- tancy, and no significant CVD. ADA, B-level recommendation; ACC/AHA, Class IIa rec- ommendation (Level of Evidence C). b. Conversely, less stringent A1c goals than the general goal of <7% may be appropri- ate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascu- lar complications, or extensive comorbid conditions or those with long-standing diabetes in whom the general goal is dif- ficult to attain despite diabetes self-man- agement education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents, including insu- lin. ADA, C-level recommendation; ACC/ AHA, Class IIa recommendation (Level of Evidence C). There are no compelling data to suggest that tight glycemic control improves out- comes in patients with HF. Observational studies suggest a potential hazard asso- ciated with lower glycemic HbA1c levels (<7%), but this may be confounded by baseline comorbid conditions. Prospective data are available only from ACCORD. There is not enough evidence to sug- gest that HbA1c targets should be dif- ferent from the targets described above. 