Measurement of Postmortem 1,5‐anhydroglucitol in Vitreous Humor for Forensic Diagnosis

Abstract

In forensic diagnosis, postmortem blood glucose is known to be susceptible to change after death. However, the 1,5-anhydroglucitol (1,5-AG) concentrations in plasma and cerebrospinal fluid (CSF) reflect the mean blood glucose level for a short period of time. In this study, we compared the postmortem 1,5-AG concentrations in vitreous humor and CSF in 47 subjects to evaluate the utility of this concentration in the vitreous humor for forensic diagnosis. The postmortem 1,5-AG concentrations in vitreous humor (mean±SD: 20.2 ± 8.7 μg/mL) and CSF (16.8 ± 8.7 μg/mL) did not differ significantly and showed a strong correlation (r(2) = 0.87, p < 0.01). These results suggest that the vitreous humor 1,5-AG concentration provides useful information on the antemortem blood glucose level, in addition to the HbA1c value and the CSF 1,5-AG concentration.

Postmortem Determination of Short-Term Markers of Hyperglycemia for the Purposes of Medicolegal Opinions

“…This confirms the usefulness of this material in postmortem chemical analysis and the possibility of its use if blood cannot be collected or at the initial stage of decomposition of the corpse. This is in line with previous reports on the usefulness of VH in postmortem diagnosis [2,13,16,28,33,34,[36][37][38][39][40].…”

“…The aforementioned authors suggest determination of 1,5-AG in VH samples, especially in cases where it is impossible to secure whole blood for HbA1c determination. Similarly, Takata et al [33] confirmed the usefulness of 1,5-AG determination in VH. In addition, Hess et al [11] demonstrated postmortem metabolic stability of 1,5-AG.…”

“…In addition, we demonstrated a high correlation between the concentration of this marker in different biological matrices (blood, serum, VH). Takata et al [33] showed a strong correlation between 1,5-AG levels in VH and cerebrospinal fluid (CSF). We also observed that in the control group 1,5-AG concentration increased with the increase in time from death to sampling, which should, however, have no effect on determining hyperglycemia as cause of death.…”

Glycated haemoglobin (HbA1c) for postmortem diagnosis of diabetes

“…Histological examinations can reveal diabetic glomerulosclerosis (Kimmelstiel Wilson syndrome or nodular glomerulosclerosis) due to angiopathy of capillaries of renal cortex and glycogen nephrosis in cases long-lasting high hyperglycaemia (Armanni-Ebstein cells in straight sections of the proximal tubules) [ 26 , 27 ]. Biochemical analyses, including blood glycated haemoglobin, fructosamin [ 8 , 20 , 28 ] and anhydroglucitol [ 29 , 30 ], determination, may complement postmortem investigations and provide useful information for determining the cause of death even in corpses with advanced decomposition. In post-mortem specimens, HbA 1c was found stable from 4 to 36 h [ 18 ] or for at least 72 h (72 or more hours following death) [ 19 , 20 ], and EDTA was found to be preferable preservative, as samples can be measured after four weeks storage at 4 °C [ 13 ].…”

Sudden Death Related to Diabetes Mellitus: Current and Emerging Relevance to the Forensic Pathologist

“…Adjuncts to the above diagnostic strategies include routine histologic evaluation in which characteristic pathology such as Armanni-Ebstein renal lesions (complete clear cell change due to renal tubular cytoplasmic glycogen deposition, as opposed to subnuclear/basal lipid vacuolization; Image 1) and Kimmelstiel-Wilson glomerular lesions is sought; the former has been reported as a strong indicator of diabetic coma (33)(34)(35)(36)(37). While some authors advocate the testing of HbA 1c , fructosamine, lactate, 1,5-anhydroglucitol, β-hydroxybutyrate, cytokines, interleukins, and α1-antitrypsin, some of which are purported to be autolysis and hemolysis resistant (38)(39)(40)(41), they may present limitations in cost and laboratory technologic capabilities, and ultimately prove unnecessary and/or inefficient in many cases, when compared with the ease and diagnostic specificity of testing for glucose and acetone.…”