HbA1c method evaluation for postmortem samples

Keltanen, Terhi; Sajantila, Antti; Valonen, Tiina; Partanen, Teija; Lindroos, Katarina

doi:10.1007/s12024-014-9638-4

Cited by 7 publications

(3 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The amount of HbA1C is compared to total hemoglobin and gives an expression of the mean blood glucose level for the previous 2 months, which is the lifespan of the reds blood cells [7]. HbA1C has gained increased interest in postmortem diagnosis of diabetes because it is a stable and a useful marker of the ante-mortem blood glucose level within 2 month [7][8][9]. Due to a rapid decrease in blood glucose concentration after death, blood glucose cannot be used for reliable identification of diabetes in postmortem cases.…”

Section: Scandinavian Journal Of Nordisk Rettsmedisinmentioning

confidence: 99%

Death from diabetic ketoacidosis in the Eastern part of Denmark in 2016-2018. Beta-hydroxybutyrate as a marker

Simonsen

Línnet

Rasmussen

2019

Scandinavian Journal of Forensic Science

View full text Add to dashboard Cite

Diabetes mellitus is a disease caused by a deficiency in (type 1) or inability to use insulin (type 2). Untreated it can lead to diabetic ketocidosis (DKA) – state with high levels of ketone bodies (acetone, acetoacetate, beta-hydroxybutyrate (BHB)). This state can be life threatening. Measurement of ketone bodies together with vitreous/urine glucose and glycosylated hemoglobin (HbA1C) are therefore essential to diagnose DKA-related deaths. All autopsy samples received at our department in the period 2016-2018 for toxicological investigations were analyzed for acetone, BHB, and vitreous glucose (N = 1394). In case of a high level of BHB, HbA1C and urine glucose were measured. Thirty two cases (2.3%) were concluded to be DKA-related deaths. Eleven (34%) of these had no known history of diabetes. BHB accounts for the major part of ketone bodies and is directly associated with the acidosis effect. Therefore, BHB is preferred to acetone when evaluating DKA and other ketoacidosis-related deaths. We compared acetone and BHB levels to evaluate if the easy acetone measurement could cover our needs for screening. We found that high BHB levels (>2000 µmol/L) were detected if the acetone cut off was set to 0.01 g/L. But, many samples would have low BHB < 3-500 µmol/L with this cut off, and many samples with raised BHB (500-1,200 µmol/L) would not be detected. We therefore recommend to screen all samples for BHB. In case of a high BHB (>1,000 µmol/L) vitreous/urine glucose and HbA1C must be measured to distinguish DKA from other types of ketoacidosis.

show abstract

Section: Scandinavian Journal Of Nordisk Rettsmedisinmentioning

confidence: 99%

Death from diabetic ketoacidosis in the Eastern part of Denmark in 2016-2018. Beta-hydroxybutyrate as a marker

Simonsen

Línnet

Rasmussen

2019

Scandinavian Journal of Forensic Science

View full text Add to dashboard Cite

show abstract

“…The amount of HbA 1c in the blood is dependent on mean glucose levels present during the 8–12 weeks preceding measurement, as HbA 1c accumulates in red blood cells during their 120-day lifespan, and therefore it is useful for long-term blood glucose control in diabetics [ 10–12 ]. For revealing undiagnosed or poorly managed diabetes in a post-mortem context, HbA 1c levels are useful for distinguishing diabetic ketoacidosis from starvation or alcoholic ketoacidosis, reveal death caused by hyperosmolar hyperglycaemic state [ 6 , 7 , 13–16 ] and diagnose fatal diabetic coma [ 17 ]. HbA 1c is relatively stable for analysing postmortem samples [ 18–20 ] and correlates well with clinical samples [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Glycated haemoglobin (HbA_1c) for postmortem diagnosis of diabetes

Lepik

Tõnisson

Kuudeberg

et al. 2018

Forensic Sciences Research

View full text Add to dashboard Cite

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.

show abstract

“…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). The fraction of hemoglobin that is glycated in the blood is determined by the amount of glucose present and the lifespan of erythrocytes, which is approximately 120 days (10,11).…”

mentioning

confidence: 99%

The Effects of Storage and Additives on Postmortem HbA1c Measurements

Fournier

Northrup

Canales

et al. 2018

Journal of Forensic Sciences

View full text Add to dashboard Cite

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.

show abstract

HbA1c method evaluation for postmortem samples

Cited by 7 publications

References 22 publications

Death from diabetic ketoacidosis in the Eastern part of Denmark in 2016-2018. Beta-hydroxybutyrate as a marker

Death from diabetic ketoacidosis in the Eastern part of Denmark in 2016-2018. Beta-hydroxybutyrate as a marker

Glycated haemoglobin (HbA_1c) for postmortem diagnosis of diabetes

The Effects of Storage and Additives on Postmortem HbA1c Measurements

Contact Info

Product

Resources

About

HbA1c method evaluation for postmortem samples

Cited by 7 publications

References 22 publications

Death from diabetic ketoacidosis in the Eastern part of Denmark in 2016-2018. Beta-hydroxybutyrate as a marker

Death from diabetic ketoacidosis in the Eastern part of Denmark in 2016-2018. Beta-hydroxybutyrate as a marker

Glycated haemoglobin (HbA1c) for postmortem diagnosis of diabetes

The Effects of Storage and Additives on Postmortem HbA1c Measurements

Contact Info

Product

Resources

About

Glycated haemoglobin (HbA_1c) for postmortem diagnosis of diabetes