Postmortem diagnosis of diabetes mellitus and its complications

Palmière, Cristian

doi:10.3325/cmj.2015.56.181

Cited by 44 publications

(52 citation statements)

References 86 publications

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“…However, using the recently developed biochemical analyses, and alternative matrices (such as vitreous humor and urine), fatal DM-related ketoacidosis is readily diagnosed, even in cases of no medical history of DM or cadavers with advanced postmortem changes [22,29,30]. Recently Palmiere discussed the caveats on using a single measurement as a definitive indication of dysregulation of glucose metabolism [31]; single measurement of glucose metabolism from any PM sample is likely unreliable. HBA1c and vitreous glucose measurements are used to assess glucose balance.…”

Section: Discussionmentioning

confidence: 99%

Challenges in investigation of diabetes-related aviation fatalities—an analysis of 1491 subsequent aviation fatalities in USA during 2011–2016

et al. 2018

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Diabetes mellitus (DM) could cause pilot incapacitation and result in aviation fatalities. The mechanisms could be directly as a consequence of acute hypoglycemia/subacute diabetic ketoacidosis (DKA) or indirectly as an acute cardiovascular event by contributing to the development of atherosclerosis in coronary or carotid and cerebral arteries. In this study, DM-related fatal flight accidents in the US National Transport Bureau's database between years 2011-2016 were analyzed with special emphasis on postmortem (PM) glucose levels and correlation of toxicological reports with anamnestic information on DM. Additionally, autopsy results on coronary arteries were reviewed. In 43 out of 1491 (~ 3%) fatal accidents pilots had DM. Postmortem glucose or glycated hemoglobin percentage (Hb1Ac) was measured in 12 of the 43 cases; while antidiabetic medication was found in 14 of the cases (only two of the cases had both glucose measurements and medication). With the increasing prevalence of DM, a possibility of pilot incapacitation due to DM or complications of DM should be actively studied, even if no anamnestic information of DM was available. While PM hypoglycemia is difficult to assess, we propose a systematic investigation based on measurement of glucose, Hb1Ac%, and ketone bodies, and documentation of atherosclerotic lesions in major arteries to identify or rule out DM as a cause of pilot incapacitation.

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Section: Discussionmentioning

confidence: 99%

Challenges in investigation of diabetes-related aviation fatalities—an analysis of 1491 subsequent aviation fatalities in USA during 2011–2016

et al. 2018

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“…Fatal diabetes mellitus complications can be hard to detect because of changing specific microscopic and macroscopic findings. The exact cause of death is determined only during autopsy (Palmiere, 2015). In daily clinical practice, glucose level in blood and glycated hemoglobin are major and frequently used worldwide laboratory findings for the diagnosis of glucose metabolism disorders (Association, 2018).…”

Section: Introductionmentioning

confidence: 99%

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

Lukočiūtė

Ginčienė²,

Chmieliauskas

et al. 2019

CBUP

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Introduction: Hyperglycemia is a consequence of uncontrolled diabetes and over a long period of time can lead to serious violations of the various systems of the body. In daily clinical practice, glucose level in blood and glycated hemoglobin are major and frequently used worldwide laboratory findings for the diagnosis of glucose metabolism disorders. In forensic medicine, the diagnostic value of post-mortem blood glucose levels is questionable because of its significant and rapid variation after death. Our research was aimed to analyse glucose concentration in blood after death and to estimate its diagnostic value. Methods: Data analysis of the State Forensic Medicine Service (SFMS) of Vilnius region of sudden death cases was performed. 238 autopsy findings were analysed. A retrospective analysis was performed using the R commander program. Results: The analysis included 238 individuals, 161 (67.6%) were men and 77 (32.4%) women. Mean age was 52.28 ± 15.45 yeras. Mean alcohol level in blood was 2.257 ± 1.482 g/L. Mean post-mortem glucose concentration in blood was 6.716 ± 5.800 mmol/l. The lowest glucose concentration was 0.600 mmol/l and the highest - 33.300 mmol/l. There were no significant glycemia level difference between men and women (p = 0.279). In 6 cases, glucose concentrations were compared before and after death. The difference in blood glucose was insignificant (p = 0.90). There was no strong correlation between ethyl alcohol and glucose concentration (r = 0.037, p = 0.667). There was a weak correlation between age and blood glucose concentration (r = 0.03, p = 0.639). Conclusions: According to SFMS autopsy data, post-mortem glucose levels remain within the normal values. Evaluation of glucose after death remains a valuable diagnostic criterion for sudden death due to hyperglycaemia, when the hyperglycaemic episode is first and fatal to the subject.

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“…Glycated hemoglobin (HbA1c) is used in postmortem investigations to detect undiagnosed or poorly managed diabetes mellitus (DM), in addition to differentiating between ketoacidosis and diabetic ketoacidosis , making it an important biomarker in death investigation. HbA1c is formed from a nonenzymatic spontaneous reaction between glucose and the β‐chain of hemoglobin .…”

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confidence: 99%

“…KEYWORDS: forensic science, glycated hemoglobin, HbA1c, diabetes mellitus, blood preservatives, ethylenediaminetetraacetic acid, sodium fluoride (NaF) Glycated hemoglobin (HbA1c) is used in postmortem investigations to detect undiagnosed or poorly managed diabetes mellitus (DM), in addition to differentiating between ketoacidosis and diabetic ketoacidosis (1)(2)(3)(4)(5)(6), making it an important biomarker in death investigation. HbA1c is formed from a nonenzymatic spontaneous reaction between glucose and the b-chain of hemoglobin (7)(8)(9).…”

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confidence: 99%

The Effects of Storage and Additives on Postmortem HbA1c Measurements

Fournier

Northrup

Canales

et al. 2018

Journal of Forensic Sciences

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HbA1c is used in forensic toxicology to identify undiagnosed diabetes mellitus (DM) and those with poor glycemic control prior to death. HbA1c is typically measured in whole blood collected in tubes containing ethylenediaminetetraacetic acid (EDTA). The effect of other additives, including sodium fluoride (NaF), is unclear. Furthermore, the assessment of short- and long-term stability of HbA1c has produced conflicting results. In this study, we collected paired postmortem blood samples in EDTA and NaF tubes (n = 142) to assess their comparability for HbA1c measurement. Stability was assessed by measuring HbA1c at baseline, 2, 3, and 4 weeks postcollection (stored at 4°C) and at 2, 4, 6, and 12 months postcollection (stored at -20°C). We found no significant difference in HbA1c between the two preservatives at any of the time points indicating NaF is a suitable preservative for HbA1c measurement. We also determined that DM status, postmortem interval, and decomposition had no effect on stability.

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Postmortem diagnosis of diabetes mellitus and its complications

Cited by 44 publications

References 86 publications

Challenges in investigation of diabetes-related aviation fatalities—an analysis of 1491 subsequent aviation fatalities in USA during 2011–2016

Challenges in investigation of diabetes-related aviation fatalities—an analysis of 1491 subsequent aviation fatalities in USA during 2011–2016

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

The Effects of Storage and Additives on Postmortem HbA1c Measurements

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