A la lumière des analyses des activités langagières du physiologiste Claude Bernard, nous étudions la création du sens dans trois manuels tunisiens et la construction d'un nouveau langage dans les débats des d'élève tunisiens pour rendre compte du phénomène de la régulation de la glycémie à travers des modèles. En proposant une stratégie innovante dans l'enseignement de la régulation de la glycémie, nous explicitons les étapes des démarches de modélisation suivies par les élèves. Le type d'analyse mené dans cette recherche a permis d'explorer les stratégies de synchronisation de la polyphonie inhérente au discours des scientifiques, des concepteurs de manuels et des élèves pour créer un nouveau sens et de pointer quelques conditions de possibilités pour aboutir à une synchronisation réussie même dans le cas d'une polyphonie complexe comme celle des élèves tunisiens qui sont bilingues. / We use the analyses of the linguistic activities of the physiologist Claude to study the creation of the direction in three Tunisian textbooks. We study also the construction of a new language in the debates by proposing a strategy innovating in the teaching of the glycemic control. We clarify the stages of the approach of modeling followed by the pupils. Tunisian Pupil gives an account of the phenomenon of the glycemic control through models. The type of analysis carried out in this research made it possible to explore the strategies of synchronization of the polyphony inherent in the speech of the scientists, the authors of textbooks and the pupils to create a new sense. We highlighted some conditions of possibilities to lead to a successful synchronization, even in the case of a complex polyphony as that of the Tunisian pupils who are bilingual.

Atualmente, o diabetes mellitus (DM) é uma doença onerosa para cofres públicos, devido às complicações micro e macrovasculares usualmente devido a não adesão à terapêutica. Tornando importante identificar novas variáveis que influenciam a não adesão à farmacoterapia, principalmente na atenção primária, onde os estudos no Brasil são escassos. Objetivo: Avaliar os fatores que influenciam a adesão a farmacoterapia em pacientes com diabetes tipo 1 (T1DM) e diabetes tipo 2 (T2DM) atendidos em uma unidade básica de saúde. Métodos: Esse é um estudo transversal realizado em pacientes com T1DM e T2DM com idades entre 18 a 90 anos, usuários de insulina e agentes anti-diabéticos selecionados de uma unidade básica de saúde do município de Franca - SP. Os instrumentos MedTake (MT), Morisky-Green (TMG), Índice de Complexidade da Farmacoterapia (ICFT), Índice de Complicações do Diabetes (CDI) e Teste Auto-Compliance (ACT) foram aplicados em todos pacientes por um único pesquisador do estudo. Os pacientes foram divididos em T1DM e T2DM com pontuações no TMG>80 para o grupo aderente e TMG<=80 para o grupo não aderente. Uma análise de regressão logística foi realizada para avaliar o efeito das variáveis na adesão ao tratamento, assim usamos como variável dependente o TMG e as variáveis independentes foram: clínicas, sociodemográficas, relacionadas aos medicamentos, CDI e Auto-Compliance. Esse modelo produziu odds ratio (OR) com medidas de associação com seus respectivos intervalos de confiança (IC). Os IC que não incluíram 1 foram considerados estatisticamente significantes (p<0.05). Para controlar os possíveis efeitos de confusão do sexo, idade e tempo de diagnóstico, o modelo de regressão logística múltipla produziu OR ajustadas. Resultados: Houve forte associação entre depressão e não adesão a farmacoterapia nos pacientes com T1DM nas faixas etárias de 41-60 anos, OR=4.6(1.4-14.2) fato que não ocorrem nas outras faixas etárias. A insuficiência cardíaca congestiva (ICC) foi associada a não adesão à farmacoterapia em pacientes com T2DM OR=2.3(1.1-5.1).9 Conclusão: Equipes multidisciplinares, gestores e formuladores de políticas públicas de saúde devem considerar a depressão e ICC no manejo dos pacientes com DM em relação a não adesão à farmacoterapia / Currently, diabetes is disease onerous to public safes due to micro and macrovasculares complications and non-adherence to therapeutic. In this sense, is crucial to identify new variables that influence the non-adherence to pharmacotherapy, mainly in the primary care, where the studies in Brazil are scared. Objective: To evaluate the factors that influence the adherence to pharmacotherapy in patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) attended in the a primary health care unit. Methods: This is a cross-sectional study in patients with T1DM and T2DM aged 18-90 years, insulin and anti-diabetic drugs users selected from a primary health care unit in Franca-SP. The MedTake (MT), Morisky-Green (TMG), Pharmaco-Complexity Index (CPI), Diabetes Complication Index (CDI) and Self-Compliance Test (ACT) instruments were applied in all patients by a single study investigator. Patients were divided into T1DM and T2DM with scores in the TMG > 80 for the adherent group and TMG <= 80 for the non-adherent group. A logistic regression analysis was performed to evaluate the effect of the variables on the adherence to the treatment, so we used as a dependent variable the TMG and the independent variables were: clinical, sociodemographic, drug related, CDI and AutoCompliance. This model produced odds ratios (OR) with measures of association with their respective confidence intervals (CI). The CI that did not include 1 were considered statistically significant (p <0.05). To control the possible confounding effects of gender, age and time of diagnosis, the multiple logistic regression model produced adjusted OR. Results:There was a strong association between depression and non-adherence to pharmacotherapy in patients with T1DM in the age groups of 41-60 years, OR = 4.6 (1.4- 14.2), a fact that does not occur in other age groups. Congestive heart failure (CHF) was associated with non-adherence pharmacotherapy in patients with T2DM OR = 2.3 (1.1- 5.1). Conclusions: Multidisciplinary teams, managers and formulators of public health policies should consider depression and CHF in the management of patients with DM in relation to non-adherence to pharmacotherapy

Introdução: Os benefícios dos ácidos graxos poli-insaturados ômega 3 (w-3) no metabolismo lipídico e na saúde cardiovascular são amplamente aceitos. Entretanto, o impacto do w-3 na composição corpórea, na homeostase da glicose e consequente modificação do risco cardiovascular não tem sido foco dos desfechos primários da maioria dos estudos clínicos. Objetivo: Avaliar o impacto da suplementação de w-3 sobre a composição corporal, o controle glicêmico e o nível de risco cardiovascular em indivíduos adultos. Métodos: A partir de uma sub-amostra do estudo CARDIONUTRI (estudo clínico, randomizado, controlado e duplo cego com seguimento de 2 meses) foram selecionados 86 indivíduos (grupo w-6, 3g de óleo de girassol/d) e 88 indivíduos (grupo w-3, 3g de óleo de peixe/d 60 por cento EPA/DHA). O efeito das intervenções foi monitorado nos tempos basal e T=8 (oito semanas). Nestes períodos foram coletadas informações demográficas, clínicas, atividade física, dieta, antropométricas e de composição corporal. Amostras de sangue foram coletadas após jejum de 12h e a partir do plasma/soro foram avaliados glicemia, insulina, colesterol total e associado a LDL e HDL, triacilgliceróis e as apolipoproteína AI e B utilizando métodos comerciais. O nível de risco cardiovascular dos indivíduos foi estimado pelo Escore de Risco de Framingham (ERF). Os resultados do efeito do tempo, da intervenção e das interações entre parâmetros monitorados e os desfechos foram analisados por meio do programa SPSS 20.0, sendo o nível de significância adotado de p<0,05. Resultados: A maioria dos indivíduos inclusos era do sexo feminino e da raça branca, sem diferença entre os grupos. As doenças mais prevalentes em ambos os grupos foram a hipertensão arterial, o diabetes mellitus e as dislipidemias. Não foram observadas mudanças de glicemia e insulina de jejum, HOMA-IR e HOMA 2- por cento S, com a suplementação de w-3, exceto nos indivíduos com risco cardiovascular intermediário, segundo o ERF. Em relação aos parâmetros antropométricos e de composição corporal, a população feminina do grupo w-3 apresentou redução do percentual de massa gorda ao longo do tempo e intervenção, assim como, foi também observada tal redução entre os indivíduos com alto risco cardiovascular. Não foi contatada variação na distribuição do ERF, apesar da melhora de seus componentes (colesterol total e HDL-C). Conclusões: A suplementação com w-3 promoveu redução de insulina e HOMA-IR nos indivíduos com ERF intermediário. Observou ainda efeito benéfico na redução do percentual de gordura corporal entre as mulheres e indivíduos com ERF alto, assim como na diminuição do colesterol total e aumento da HDL-C. / Introduction: The benefits of polyunsaturated omega 3 (n-3) on lipid metabolism and cardiovascular health fatty acids are widely accepted. However, the impact of n-3 in body composition, glucose homeostasis and consequent modification of cardiovascular risk has not been the focus of the primary outcomes of most clinical trials. Aim: To evaluate the impact of n-3 supplementation on body composition, glycemic control and the level of cardiovascular risk in adults. Methods: From a subsample of CARDIONUTRI study were selected (clinical, randomized, controlled, double blind study with follow-up of 2 months) 86 patients (group n-6, 3g of sunflower oil/d) and 88 individuals (n-3 group, 3g fish oil/d - 60 per cent EPA/DHA ). The effect of the interventions was monitored at baseline and T = 8 (eight weeks). In these periods were collected demographic information, clinical, physical activity, diet, anthropometric and body composition. After 12h fasting, blood samples were collected and, from plasma/serum, were evaluated glucose, insulin, total cholesterol, cholesterol associated with LDL and HDL, triacylglycerol, apolipoprotein AI and B using standard methods. The level of cardiovascular risk of individuals was estimated by the Framingham Risk Score (FRS). The results of the effect of the time of the intervention and the interactions between monitored parameters and outcomes were analyzed using the SPSS 20.0 program and the level of significance of p < 0.05. Results: The majority of individuals included were female and white, with no difference between groups. The most prevalent diseases in both groups were hypertension, diabetes mellitus and dyslipidemia. No change was observed in glucose and fasting insulin, HOMA-IR and HOMA 2- per cent S, with supplementation with n-3, except in patients with intermediate cardiovascular risk, according to the FRS. Regarding the anthropometric and body composition parameters, the n-3 group showed a reduction in the percentage of fat mass among females over time and intervention, as was also observed that reduction among individuals at high cardiovascular risk. There was no variation in the distribution of the ERF, despite the improvement of its components (total cholesterol and HDL-C). Conclusions: Supplementation with n-3 promoted reduction of insulin and HOMA-IR in subjects with intermediate FRS. It noted beneficial effect in reducing the percentage of body fat among women and individuals with high FRS, as well as decreased total cholesterol and increased HDL-C.

O objetivo deste estudo foi avaliar, por meio de estudo caso-controle, a frequência de complicações do tratamento odontológico invasivo em pacientes com diabetes mellitus (DM) tipo 2, de acordo com o controle glicêmico da doença, e sugerir valores de glicemia em jejum e HbA1c que poderiam ser considerados seguros para se evitar estas complicações. Pacientes portadores de DM tipo 2 e indivíduos não diabéticos foram divididos em três grupos: grupo I 13 indivíduos diabéticos tipo 2 com controle glicêmico adequado; grupo II 15 indivíduos diabéticos tipo 2 com controle glicêmico inadequado; Grupo III 18 indivíduos não diabéticos (controle). Os pacientes diabéticos deveriam ter o diagnóstico baseado nas recomendações da Organização Mundial de Saúde. Os pacientes do grupo I foram caracterizados por apresentar glicemia em jejum&le; 140mg/dl e HbA1c&le; 7%; os do grupo II por apresentar glicemia plasmática de jejum > 140mg/dl e HbA1c > 7%; e os do grupo III por não ter os sintomas do DM e apresentar valores de glicemia plasmática de jejum menores que 100mg/dl. Foram selecionados os pacientes com necessidade de exodontia ou raspagem/alisamento radicular. Nos pacientes diabéticos, previamente ao atendimento odontológico, foi avaliada glicemia plasmática de jejum, hemoglobina glicada (HbA1c), e glicemia capilar. Sete dias após o procedimento odontológico foi avaliada a frequência de complicações clínicas (infecção do sítio cirúrgico e infecção sistêmica) nos três grupos de estudo, e a correlação entre a ocorrência das complicações com o controle glicêmico do DM. A frequência do desfecho clínico foi baixa (8,6%) e não houve diferença entre a frequência do desfecho e os grupos de estudo (Teste exato de Fisher; P > 0,05). As exodontias estão mais associadas à ocorrência de complicações, do que a raspagem/alisamento radicular. Entretanto, não foi possível determinar a relação direta entre os valores de glicemia de jejum e HbA1c e as complicações pós-operatórias, nem sugerir valores preditivos das complicações, uma vez que elas ocorreram tanto em indivíduos com DM tipo 2 controle glicêmico adequado, com controle inadequado e nos não diabéticos. Possivelmente, estudos com maior número de pacientes permitam avaliar o impacto do controle glicêmico na ocorrência ou não de complicações pós-operatórias. / The purpose of this study was to evaluate, in a case-control study, the frequency of clinical outcomes of complications related to invasive dental treatment in diabetic type 2 patients in relation to glycemic control, and suggest levels of fasting blood glucose and glycated hemoblobin that could be considered safe to avoid complications related to invasive dental treatment. Diabetic type 2 patients and non-diabetic patients were selected and divided in 3 groups: group I 13 diabetic type 2 patients with adequate glycemic control; group II 15 diabetic type 2 with inadequate glycemic control; and group III 18 non-diabetic patients (control group). Diabetic patients should have the diabetes diagnosis based on World Health Organization (WHO) recommendations. Patients of group I were characterized by present fasting blood glucose &le;140mg/dl e HbA1c &le; 7%; patients of group II were characterized by present fasting blood glucose > 140mg/dl and glycated hemoglobin > 7%; and patients of group III should not present any symptoms of diabetes and present levels of fasting blood glucose lower than 100mg/dl. Patients in need of extraction or scaling/root planning were selected. In diabetic patients, previously to dental assistance, was evaluated fasting blood glucose, glycated hemoglobin and fingerstick capillary glycemia. Seven days after the dental procedure, the frequency of clinical outcomes (surgery site infection and systemic infection) on the three study groups was analyzed, and the correlation between the occurrence of these complications and the glycemic control of DM. The frequency of the clinical outcomes was low (8.6%) and there was not difference between the clinical outcomes frequency and the study groups (Fisher exact test; P > 0.05). Dental extractions were associated to complications compared to scaling/root planning. However there was not association between the clinical outcomes occurrence and the glycemic control of DM after the dental procedures and it was not possible to determine predictive values of fasting blood glucose and glycated hemoglobin for these clinical outcomes. Probably, studies with larger numbers of patients allow assessing the impact of glycemic control on occurrence of postoperative complications.

Background: Findings are inconsistent regarding the degree to which depression may exert a negative impact on glycemic control in patients with type 2 diabetes. We therefore aimed to examine the longitudinal relationship between depression, behavioral factors, and glycemic control. Methods: In a prospective component of a nationally representative sample, 866 patients with type 2 diabetes aged ≧18 years completed a standardized assessment including a laboratory screening, questionnaires, and diagnostic measures. Subsequent to baseline (t0), patients were tracked over a period of 12 months (t1). Depression was assessed according to DSM-IV and ICD-10 criteria. Glycemic control was determined by levels of glycosylated hemoglobin (HbA1c); a level of ≧7% was judged as unsatisfactory. Regression analyses were performed to analyze the prospective relationship between depression, medication adherence, diabetes-related health behavior, and HbA1c. Results: Patients with depression at t0 revealed increased rates of medication nonadherence (adjusted OR: 2.67; CI: 1.38–5.15) at t1. Depression (adjusted regression coefficient: β = 0.96; p = 0.001) and subthreshold depression (β = 1.01; p < 0.001) at t0 also predicted increased problems with diabetes-related health behavior at t1. Adjusted ORs for poor glycemic control (HbA1c ≧7%) at t1 were also increased for patients with baseline depression (2.01; CI: 1.10–3.69). However, problems with medication adherence as well as problems with diabetes-related health behavior at t0 did not predict poor glycemic control at t1. Conclusions: In a prospective representative study of patients with type 2 diabetes, baseline depression predicted problems with medication adherence, problems with health-related behaviors, and unsatisfactory glycemic control at follow-up.

PURPORSE¡GThis purpose of the study is to investigate the effectiveness of diabetes shared care model (DSCM)and the factors associated with extent of glycemic control. METHOD¡GWe analyzed 212 patients who completed the five shared care visits and 739 patients who completed the second follow-up visit. Patients are recruited from a department of Endocrinology of medical center located in southern part of Taiwan. Data used in this study were collected from the patients¡¦ medical records. To evaluate effectiveness of diabetes shared care model¡]dietary compliance, exercise behavior compliance, clinical indicators¡^and to examine the factors associated with the hemoglobulin A1c is the purpose of the study. RESULT¡G In 212 patients completing the 5 visits, the compliance of carbohydrate consumption was significantly improved, however, there was no significant improvement in those of calories and fat consumption. Further analysis in 739 patients who completed the second follow-up visit, we found that the compliance of calories and fat consumption was significantly improved. The compliance of carbohydrate was improved, but not reaching significant difference. Although the compliance of 212 patients¡¦ exercise behavior was not significantly improved, the compliance of 739 patients¡¦ exercise behavior was significantly improved. The improvement of clinical indicators following participating the DCSM are as followed¡G 1.The hemoglobulin A1c¡]before¡G8.1% vs after¡G7.9%¡AP=0.04¡^¡Bfasting plasma glucose¡]before¡G164.1mg/dL vs after¡G136.8 mg/dL¡AP<0.01¡^¡Btotal cholesterol ¡]before¡G200.9mg/dL vs after¡G187.3 mg/dL¡AP<0.01¡^¡Blow density lipoprotein¡]LDL¡^¡]before¡G121.0mg/dL vs posttest¡G113.1 mg/dL¡AP<0.01¡^¡Bhigh density lipoprotein¡]HDL¡^¡]before¡G42.6mg/dL vs posttest¡G46.2 mg/dL¡AP<0.01¡^of 212 patients were significantly improved. On the other hand, the triglyceride¡]pretest¡G159.9mg/dL vs after¡G152.2 mg/dL¡AP=0.71¡^¡Bsystolic blood pressure¡]before¡G132.5mmHg vs after¡G137.3 mmHg¡AP=0.34¡^and diastolic blood pressure¡]before¡G79.5 mmHg vs after¡G78.4 mmHg¡AP=0.09¡^of 212 patients were not significantly improved. 2.In 739 patients who only completing the second follow-up visit, the hemoglobulin A1c¡Bfasting plasma glucose¡Bdiastolic blood pressure were significantly improved but the systolic blood pressure was remain unchanged. Finally, multivariate regression modeling was used to investigate the factors associated with extent of glycemic control improvement (first visit HbA1c-annual visit HbA1c) in 212 patients competing the annual visit. After adjusting for age and sex, patients¡¦ sex, level of first visit hemoglobulin A1c and level of first visit triglyceride was associated with the extent of glycemic control.

Individual day-to-day management and effective control of type 1 diabetes (T1D) is ultimately driven by decisions made by the individual. Individuals with attention deficit hyperactivity disorder (ADHD) have a higher tendency to be inattentive, impulsive, and hyperactive. Attention deficits and impulsivity among adolescents and adults with T1D could result in poor diabetes management through infrequent self-monitoring of blood glucose and inadequate insulin dosing – key components of achieving optimal glycemic control. This study included 7,380 adolescents and young adults, ages 13-25 years, participating in the T1D Exchange clinic registry (median age 17.4 years, duration 7.7 yrs, 50% female, 81% white). Participants were classified into 3 groups for the primary analyses using participant reported diagnosis and medication use: 1) No ADHD; 2) ADHD with current medication; 3) ADHD without current medication. Groups were compared in logistic and linear regression models for: self-monitoring of blood glucose (SMBG) /day, missed insulin dose ≥1 time/week, HbA1c, and at least 1 diabetic ketoacidosis (DKA) and severe hypoglycemic (SH) event in the past 3 months. Overall, 774 (10%) participants reported a diagnosis of ADHD of whom 371 currently took medication. Mean SMBG/day was 4.7, 5.0, and 4.9 in the ADHD w/o meds, ADHD with meds, and no ADHD groups, respectively. ADHD patients w/o meds (36%, P=0.02) or with meds (39%, P=0.003) were more likely to report missing insulin doses compared with no ADHD pts (30%). Mean HbA1c was higher in ADHD w/o meds (9.0%, P<0.001) and ADHD with meds (8.9%, P=0.002) compared with no ADHD pts (8.6%). The odds of having at least one DKA event in the past 3 months was 1.8 and 1.5 times higher in the ADHD w/o meds (P<0.001) and ADHD with meds (P=0.01) group compared with no ADHD. The ADHD w/o meds group was significantly more likely to have had a SH event (OR 1.7 95% CI 1.2-2.3; P<0.001) compared with the no ADHD group but the occurrence of SH in the ADHD with meds group was similar to the no ADHD. Results of this study supported the working hypothesis that ADHD without treatment with medication has a negative impact on aspects of diabetes management and glycemic control. Participants with ADHD with and without medication were more likely to miss insulin doses, less likely to use an insulin pump, more likely to have high HbA1c levels, and had a higher frequency of DKA and SH. These results have important public health implications for adolescents and young adults with T1D who are already at risk for poor glycemic control. Since ADHD has a meaningful impact on glycemic outcomes it is important for providers of adolescents and young adults with T1D to review history and signs of an ADHD diagnosis along with diagnosis of other psychosocial disorders with their patients and consider recommending psychosocial services.

Hyperglycemia in adult cardiac surgery may result in post-operative sternal wound infections, pneumonia, renal failure, increased length of stay, and cost. The Surgical Care Improvement Project (SCIP) (2006) requires blood glucose control in cardiac surgery at 6:00 am on post-operative day one (POD1) and post-operative day two (POD2) to be 200mg/dL or less. Enhanced Recovery After Surgery (ERAS) guidelines use a Maltodextrin 12.5% carbohydrate beverage six hours and two hours pre-operative of general surgery to improve post-operative outcomes, cost, and length of stay. One study replicated ERAS guidelines in adult coronary artery bypass grafting surgery patients finding patients had decreased length of stay and improved glycemic control six hours postoperatively. The purpose of this quality improvement project is to outline a proactive approach to the modifiable risk factor of pre-operative fasting. This quality improvement project describes a pre-operative fasting carbohydrate protocol for non-emergent, adults, scheduled for cardiac surgery at 10:00am or later, with a hemoglobin A1C of 8.4% or less, and a body mass index of 35 or less. The protocol is named the Hungry Sweet Heart Protocol and an implementation plan is described for a community hospital located in Tucson, AZ. Updating practices of strict NPO status prior to cardiac surgery is a proactive measure to improve glycemic control and adherence to SCIP guidelines post-operatively. Interdisciplinary teams, including DNPs, are perfectly suited to guide this implementation.

Stress induced hyperglycaemia is prevalent in critical care. Since the landmark paper published by Van den Berghe et al. (2001) a great deal of attention has been paid to intensive insulin therapy in an ICU setting to combat the adverse effects of elevated glucose levels and poor glycaemic control. Glycaemic control protocols have been extensively developed, tested and validated within an ICU setting. However, little research has been conducted on the effects of a glycaemic control protocol in a less acute ward setting. There are many additional challenges presented in a ward setting, such as the variation in meals and levels of activity between patients, from day to day and throughout the day. A simple compartment model is used to describe the nature of insulin and glucose metabolism in patients of the Cardiothoracic Ward (CTW). A stochastic model of the fitted insulin sensitivity parameter is generated for this cohort and validated against cohorts of similar characteristics. The stochastic model is then used to run simulations of predictive control on 7 CTW patients, which shows significantly tighter glucose control than what is obtained with regular clinical procedures. However, the rate of severe hypoglycaemia is an unacceptably high 4.2%. The greatest challenge in maintaining tight glycaemic control in such patients is the consumption of meals at irregular times and of inconsistent quantities. Insulin sensitivity was compared to extensive hourly clinical data of 36 ICU patients. From this data a sepsis score of value 0-4 was generated as gold standard marker of sepsis. Comparing the sepsis score to insulin sensitivity found that insulin sensitivity provides a negative predictive diagnostic for sepsis. High insulin sensitivity of greater than Si = 8 x 10⁻⁵ L mU⁻¹ min⁻¹ rules out sepsis for the majority of patient hours and may be determined non-invasively in real-time from glycaemic control protocol data. Low insulin sensitivity is not an effective diagnostic, as it can equally mark the presence of sepsis or other conditions.

O diabetes mellitus (DM) é uma doença que está associada com aumento da morbidade, mortalidade e custos econômicos. O DM tipo 2 é a forma de diabetes mais comum, acometendo 85%-90% de todos os casos. O mau controle glicêmico é um fator determinante do desenvolvimento e progressão das complicações do DM. A hemoglobina glicada (A1C) se tornou a medida de referência para o controle de DM por mais de duas décadas. Existe um grande incentivo, tanto da perspectiva de saúde pública quanto da clínica, em detectar pessoas com risco futuro de desenvolver DM2, pois este é um forte fator de risco para doença cardiovascular. Também existem evidências que é possível prevenir ou retardar o DM nas pessoas com tolerância a glicose diminuída, desde que estes casos sejam identificados e tratados adequadamente. Os testes disponíveis hoje para o diagnóstico do DM, glicemia de jejum (GJ) e teste oral de tolerância à glicose (TOTG), carecem de sensibilidade e/ou especificidade. Recentes estudos têm evidenciado que a A1C pode ser uma nova ferramenta para diagnóstico do DM, sendo que diversos pontos de corte tem sido estudados. Maiores investigações para a validação do desempenho diagnóstico deste teste na predição do DM são necessárias para podermos utilizar esta ferramenta com segurança na triagem e diagnóstico do DM. / Diabetes mellitus (DM) is a disease associated with greater mortality and economical costs. Type 2 DM is the commonest form of DM, accounting for 85-90 % of its cases. Glycemic levels are a determinant factor for the development and progression of DM complications. Glycated hemoglobin (A1C) became the reference measure of glycemic control for more than two decades. There is a great incentive in detecting persons with future risk of developing DM, because this is a strong risk factor for cardiovascular disease. Also there are evidences that it is possible to prevent or to delay DM in persons with prediabetes, since identified and treated appropriately. Available tests for DM diagnosis, fasting glycemia (FG) and oral glucose tolerance test (OGTT), lack sensibility and/or specificity. Recent studies have shown that A1C can be a new tool for DM diagnosis and several cutoff points have been analyzed. However, the validation of this test as diagnostic modality to detect DM might be necessary in order to provide a useful tool for DM diagnosis.