SOFT - TIAFT 1998 Poster Session 3 Thursday October 8, 1998

J. Robert Swanson1,2, Alane Olson2 and Wm. Michael Ivie1

1. Kaiser Regional Laboratory, Clackamas, OR 97015, USA
2. Pathology Department, Oregon Health Sciences University, Portland, OR 97201, USA

Diabetes is one of the most common diseases and death from diabetic ketoacidosis (DKA), an acute complication, is common in death investigation practice. A diabetic history and high vitreous glucose and blood acetone concentrations are helpful for establishing DKA as the cause of death. HbA1c which is roughly proportional to the integrated average blood glucose level, is very widely used to monitor and manage treatment of diabetic patients. We decided to test whether HbA1c in postmortem blood would be a reliable indicator of the deceased's diabetic status.

Blood samples from diabetic and non-diabetic cases were assayed for HbA1c with the Biorad VariantTM ion exchange HPLC system using the procedure recommended by the manufacturer. The reference range for non-diabetics is up to 6%. Diabetics with values less than 8% are considered to be in good control. The results from 13 diabetics were mean 8.9%, range 6.2-12.1 and for 16 non-diabetics mean 5.4%, range 4.5-6.4.

One of the diabetics was a gestational diabetic who died unexpectedly within a few days of delivery. Her HbA1c was 7.1%. In addition to these cases there were three more that apparently died in DKA and had not been previously diagnosed as diabetic. The HbA1c values were12.2, 12.6 and 13.8%. Other results were consistent with DKA at the time of death: vitreous glucose was greater than 600 mg/dL in all three and two of the three cases had high blood acetone levels.

For another four cases HbA1c could not be measured due either to the presence of variant hemoglobins or to the presence of unusual or unresolved peaks. Sample degradation may be responsible for some of these problems.

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