Abstract
Diabetes mellitus is classified as the epidemic of the 21st century. Due to the fact that acute carbohydrate metabolism disorders usually do not indicate morphological change, postmortem diagnosis is required to perform biochemical tests. The authors decided to evaluate the usefulness of determining glucose, lactate, acetone, β-hydroxybutyric acid (BHB), and 1,5-anhydroglucitol (1,5-AG) in postmortem blood/serum, urine, and vitreous humor (VH). Biological material was collected during autopsies. The study group consisted of 50 diabetics, while the control group consisted of 50 non-diabetics, who died a sudden death, with negative test results for the presence of ethyl alcohol and were not resuscitated before death. Statistical analysis was performed using the IBM SPSS Statistics 25 software package. The most statistically significant difference between the two groups was observed for mean 1,5-AG concentration. The authors found many correlations between the concentration of the examined markers in different materials, mainly between blood/serum and VH. The most suitable short-term glycemic marker in postmortem diagnosis is 1,5-AG. Diagnosis may be supported with determinations of acetone and BHB. For medicolegal assessment, the interpretation of the biochemical test results should comprise information on circumstances of death, medical history, results of other toxicological and histopathological tests, and autopsy report.
Highlights
Diabetes mellitus is considered to be an epidemic of the 21st century
The mean glucose concentration in urine and vitreous humor (VH) was significantly higher in the study group
The mean serum glucose concentration in the control group was significantly higher compared to the study group, while the mean glucose concentration was significantly higher glucose concentration in the interlethal period due to glucose consumption by body cells and bacteriae as well as an increase in lactate concentration resulting from postmortem anaerobic glycolysis [13]
Summary
Diabetes mellitus is considered to be an epidemic of the 21st century. According to the data of the International Diabetes Federation (IDF), in 2019 there were approximately 463 million adults aged between 20 and 79 years living with diabetes worldwide and by 2045 this number is expected to rise to 700 million, including 68 million in Europe. Deaths due to acute carbohydrate metabolism disorders usually do not show morphological changes [2]. In many cases, this makes it impossible for a pathologist to make a final diagnosis exclusively on the basis of the autopsy results and standard histopathological and toxicological tests [3]. Often characterized by a dynamic course, may occur at any stage of the disease [4]. Acute hyper- and hypoglycemia cause sudden death in different age groups, including children with type 1 diabetes mellitus. A postmortem diagnosis of glycemic disorders may require the performance of biochemical tests not Diagnostics 2020, 10, 236; doi:10.3390/diagnostics10040236 www.mdpi.com/journal/diagnostics
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