Post-Mortem Assessment of Glycemic Control in Sudden Diabetic Deaths Using Glycated Hemoglobin (HbA1c)
Iraqi Postgraduate Medical Journal,
2016, Volume 15, Issue 4, Pages 493-498
Post-mortem diagnosis of uncontrolled diabetes and its complications remains a common problem due to lack of unequivocal biochemical or histological proof of hyper or hypoglycaemia.In this study we evaluated glycated hemoglobin (HbA1c) as a post-mortem tool to identify uncontrolled diabetes.
To assess the use of glycated hemoglobin as an indicator for glycemic control in sudden diabetic deaths.
A cross-sectional study was carried out in the period from January 2015 to December 2015 on 47 sudden diabetic deaths and 22 natural non diabetic deaths at the Medico-Legal directorate in Baghdad. Information was collected from relatives, medical and police reports. A blood samples were drawn from the right ventricle of the heart of each decedent included in this study during autopsy. Blood was collected into sealed plastic tubes containing EDTA as anticoagulant and stored at 4ᵒc temperature. These samples were analyzed within a period of 48 hours. One micro liter sample of thoroughly mixed whole blood was placed into the glass capillary tube provided in the HbA1c reagent kit and analyzed with variant-Hb- testing system. Data were recorded in the SPSS for window 11.0.
The study showed that the mean age group of diabetic sudden death was 50.28+-10.01 while 44.36+-16.11 year was non diabetic sudden death.
Male gender was the predominant in both groups (diabetic and non diabetic) 27.30%, 21.30% respectively.
%HbA1c was significantly deferred in diabetic and non diabetic group, when it was positive 100% in diabetic group, while it’s negative in non diabetic group (the cut off point is 6.5).
Type 2 diabetes was the predominant over type 1 with 59.60% and 40.40% respectively. The main system involved in sudden death in both study groups was the cardiovascular system accounting for 48.94% in diabetic group and 40.91% in control group, with the predominance of ischemic heart disease as the main cause of death in the system involved in both study groups accounting 40.43% for diabetic group and 22.73% for control group.
HbA1c considered more reliable than post mortem glucose levels and provide guidance in the diagnosis of chronic diabetes mellitus in medico-legal autopsy cases.
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