INS and diabetes mellitus: Conversely, less stringent HbA1c goals than the general goal of <7% may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions (Table 3), or those with long-standing diabetes in whom the general goal is difficult to be attained despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents including insulin.