Glycated haemoglobin (HbA_1c) for postmortem diagnosis of diabetes

Abstract

The study was conducted at the Estonian Forensic Science Institute in 2008–2014 as continuous part of our previous study of alcohol and premature death in Estonian men. Autopsy data from 504 cases of male deaths (ages 19–79) were collected and blood and urine samples for glycated haemoglobin (HbA1c), liver enzymes and alcohol concentration were analysed. The aim of our research was to find undiagnosed diabetes and diabetes risk cases postmortem on the basis of increased values of HbA1c. HbA1c was within the reference value 4.8%–5.9% (29–42 mmol/mol), in 88.1% (n = 444) of cases, below reference value in 2.4% (n = 12), in the risk group of diabetes, HbA1c 6.0%–6.4% (42–46 mmol/mol) was within 5.8% (n = 29), and HbA1c result of ≥6.5% (48 mmol/mol) manifested in 3.8% (n = 19) of cases. The higher the age, the more cases with HbA1c value ≥6.0% (42 mmol/mol) occurred. In the group of external causes of death (n = 348), the HbA1c value of ≥6.5% (48 mmol/mol) HbA1c occurred in four cases. The HbA1c value was ≥6.5% (48 mmol/mol) in 78.9% of 156 cases when the cause of death was disease, of which 58% were cardiovascular diseases. The prevalence of diabetes and diabetes risk was found lower compared to population-based study, as majority of the deceased were young and middle-aged males and no females were included. In the case of poisoning with narcotic substances, HbA1c was within the reference range. A negative correlation occurred between alcohol intoxication and HbA1c value. A positive correlation between ALT and HbA1c was found – the higher stage of liver damage correlated with the higher HbA1c level.

The Post-Mortem Evaluation of Glucose Concentration in Blood and Its Diagnostical Value

“…According to Cornelius Hess et al glucose concentration in vitreous fluid correlate with glycaemia previous to death ( Cornelius Hess, Musshoff, & Madea, 2011;. Moreover, estimation of HbA1c, fructosamine, or anhydroglucitol may provide useful data on the long-term glycemic control for individuals with diabetes (C. Hess et al, 2013;Lepik, Tõnisson, Kuudeberg, & Väli, 2018;Walta, Keltanen, Lindroos, & Sajantila, 2016). Though it has been thought that the glucose concentration in blood doesn't have high diagnostic validity because of its broad variation after death there are some studies that suggest post-mortal blood glucose analysis can be a useful diagnostic tool.…”