People with type 2 diabetes mellitus are at high risk of morbidity and mortality from cardiovascular disease (CVD). Based on observed relationships between hyperglycemia and CVD, several large clinical trials have investigated the ability of treatment strategies to achieve hemoglobin A less than 7% (53 mmol/mol) as a way of reducing this risk. These studies demonstrate that intensified glycemic therapy may reduce CVD risk in younger patients with recent-onset type 2 diabetes mellitus but not in high-risk older individuals with established disease. Attention to blood pressure and lipid-lowering therapies with modified glycemic goals for older high-risk individuals is recommended.