Plasma glucose and levels should be followed up regularly, with appropri- ate adjustments made in insulin and oral hypoglycemic thera- pies. Lowering the HbA1c to 7% is a reasonable goal for most patients because this has been shown to reduce microvascular diabetic complications and, if initiated early, may also be asso- ciated with a reduction in macrovascular disease.269 A strin- goal such as 6.5% may be beneficial if treatment is not associated with hypoglycemic episodes, but it may be more reasonable to consider a less stringent goal of 8% for elderly patients and others who are prone to hypoglycemia.269 Unlike microvascular disease such as retinopathy, the progression of macrovascular disease such as CAD does not always correlate with the intensity of glucose control. However, in the Diabetes Control and Complications Trial, intensive glucose control (target HbA1c , 6%) in type 1 diabetic patients was associated with a lower risk of cardiovascular disease. Patients who were randomized to intensive glucose control after 9 years of follow-up had a 57% reduction in the risk of nonfatal MI, stroke, or cardiovascular death compared with patients in the standard arm.284 For patients with type 2 diabetes mellitus, evidence also exists that a more intensive control of plasma glucose may reduce macrovascular cardio- vascular disease. 