International Circulation: In the 2011 guidelines for secondary prevention in patients with coronary and other atherosclerotic vascular disease， the recommendations for glycosylated hemoglobin control was downgraded to a level 2B of evidence. At present， how should a physician set a goal for glycemic control in individual patients?
　　Dr Smith: In looking at secondary prevention， we of course emphasize statins and aspirin and control of blood pressure and we think that the control of diabetes is very important. The major benefits in controlling diabetes have been microvascular; the eyes and the kidneys really show significant benefits. There has been an argument based on some recent studies on the control of HbA1c as to whether or not very tight control would make a difference. For that reason， the current secondary prevention guidelines decided we would stay with the number of 7% as a good target and that we would urge cardiologists to be sure that if their patients were approaching 7， if further fine tuning was needed， that is a situation where a partnership with an expert in endocrinology would be helpful. I think in many patients， lower is better. That is my personal opinion. There are some older patients and higher risk patients where trying to get to an HbA1c of <7， perhaps 6.5， you can get swings in the HbA1c and that can be difficult. So in general， we are emphasizing an HbA1c of 7% and if it needs to be tighter to really get involved with a diabetologist recognizing the major benefits from HbA1c will probably be microvascular， but I personally feel that people with diabetes need to be controlled and that 7 is a reasonable target to shoot for.

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