An important risk factor for the development of HF in patients with diabetes mellitus is abnormal glucose con- In a large cohort study of nearly 50000 dia- betic patients without HF at baseline, each 1% increase in HbA1c was associated with an 8% increased risk of In a similar study of patients with diabetes mellitus enrolled in the ARIC study, the adjusted HR of HF for for individuals without coronary heart disease at baseline and 1.20 (95% CI, 1.04 1.40) for those with coronary heart disease at baseline.119 The increased risk for the development of HF with increasing HbA1c in ARIC was also present in patients in the absence of incident coro- In the CHS (Cardiovascular Health Study), elevated fasting glucose among older adults with diabetes mellitus was also independently associated with incident HF.121 Despite the epidemiological data linking worse gly- cemic control to greater rates of HF in observational studies and clinical trials, data from randomized, con- trolled, clinical trials of more intensive glucose control have not demonstrated a benefit in HF reduction with intensive glycemic control. In a meta-analysis of 8 ran- domized, controlled trials (that included a total of 37229 patients) comparing more with less intensive glucose- lowering strategies, the risk of HF-related events did not differ significantly between more intensive regimens and standard therapy despite achieving an average HbA1c In subgroup analyses limited to clinical trials specifically designed to compare strategies targeting more intensive and standard glycemic control (VA-CSDM [Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type II Diabetes] Feasibility, UKPDS [United Kingdom Prospective Diabetes Study], ADVANCE [Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation], ACCORD [Action to Control Cardiovascular Risk in Diabetes], and VADT [Vet- erans Affairs Diabetes Trial]), intensive glucose-lowering strategies were not associated with a reduced risk of HF compared with standard regimens (odds ratio, 1.02; Glycemic Control and Outcomes in Patients With Established HF In patients with established HF at baseline, the relation- ship between glycemic control and outcomes has not been clearly defined. 