very intensely and got those down to very good numbers. We also had the patients on aspirin and encouraged diet and exerciseall the things that you're supposed to doand once that was done, I was not surprised that glucose lowering had no additional effect. Maybe a little disappointed, but not particularly surprised."Commenting on the results for heartwire, Dr Roger Blumenthal (Johns Hopkins, Baltimore, MD) pointed out that tight glycemic control earlier in the disease processACCORD, ADVANCE, and VADT were carried out in individuals with established disease for a mean duration of eight to 11 yearsmight have been more successful.Dr Sherita Golden (Johns Hopkins) echoed Blumenthal's sentiments."We all do still wonder if tight control earlier after diagnosis is most beneficial. After an individual has had diabetes for a prolonged time, the horse is out of the barn, so to speak, and tight glucose control is not as effective," said Golden.She added that getting HbA1c levels down to 7% is still effective in preventing macrovascular complications, "so tight control to this level is still beneficial." In addition, tight control of blood pressure and cholesterol are proven strategies for primary and secondary prevention of cardiovascular disease in diabetes, she said.Position statement on intensive glycemic control issuedWith the publication of VADT and the earlier publications of ACCORD and ADVANCE, the ADA, American Heart Association (AHA), and American College of Cardiology (ACC) issued a position and scientific statement on intensive glycemic control and the prevention of cardiovascular events [2]."The lack of significant reduction in cardiovascular disease events with intensive glycemic control in ACCORD, ADVANCE, and VADT should not lead clinicians to abandon the general target of an A1c less than 7.0% and thereby discount the benefit of good control on serious and debilitating microvascular complications," write first author Dr Jay Skyler (University of Miami, FL) and colleagues in the statement, published online December 17, 2008 in Circulation.The report emphasizes the importance of controlling nonglycemic risk factors, such as blood pressure and lipids (using statins), as well as using aspirin and lifestyle modifications as the primary strategies for reducing the burden of cardiovascular disease in people with diabetes.The group states that based on ACCORD, ADVANCE, and VADT, there is no need for major changes in glycemic-control targets but does offer some "clarification of the language that has consistently stressed individualization."Lowering HbA1c levels to <7% to reduce microvascular and neuropathic complications in type 1 and 2 diabetes remains a class I recommendation. Less than 7% is also a reasonable target for reducing the risk of macrovascular complications, a class IIb recommendation, at least until more evidence becomes available, they add.The scientific statement is also published in the Journal of the American College of Cardiology and Diabetes Care.Treat the cardiovascular risk factorsRegarding the clinical implications of the study, Duckworth, like the ADA, AHA, and ACC, emphasized the importance of treating blood pressure and lipid abnormalities to reduce the risk of cardiovascular and microvascular complications from diabetes. He added that VADT, as well as ACCORD and ADVANCE, included older patients and that younger patients might be treated differently."I have a practice