Usefulness of postmortem 1,5-anhydroglucitol analysis in forensic diagnosis

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  • TAKATA Tomoyo
    Department of Medical Technology, Faculty of Health Science, Ehime Prefectural University of Health Sciences Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • YAMASAKI Yukie
    Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • KITAO Takashi
    Department of Medical Technology, Faculty of Health Science, Ehime Prefectural University of Health Sciences Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • MIYAISHI Satoru
    Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences

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  • 死後の血漿および脳脊髄液の1,5-アンヒドログルシトール値による糖尿病の法医診断における有用性

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Abstract

For postmortem diagnosis of diabetes mellitus including fulminant type 1 diabetes, it is necessary to determine the blood glucose concentration before death, and the concentrations of plasma and cerebrospinal fluid 1,5-anhydroglucitol (1,5-AG) and HbA1c were investigated in 59 individuals including diabetic patients (n = 13) and nondiabetic subjects (n = 46) without renal failure on the basis of anamnesis. The postmortem 1,5-AG concentration in the plasma showed linearity with that in the cerebrospinal fluid (r = 0.59). The mean 1,5-AG concentrations in the plasma and cerebrospinal fluid were significantly lower in diabetes mellitus patients than in nondiabetic subjects (plasma 1,5-AG: 6.8 ± 8.3 µg/mL (diabetes mellitus) vs 23.6 ± 13.0 µg/mL (nondiabetes mellitus); cerebrospinal fluid 1,5-AG: 6.1 ± 5.3 µg/mL (diabetes mellitus) vs 19.4 ± 7.9 µg/mL (nondiabetes mellitus)). The plasma and/or cerebrospinal fluid 1,5-AG concentrations in all the diabetic patients were low. Furthermore, the plasma and cerebrospinal fluid 1,5-AG concentrations in nondiabetic subjects with HbA1c 6.5% or more was low. In nondiabetic subjects with normal HbA1c, only the plasma 1,5-AG concentration was low in those who died because of drowning. In conclusion, we consider that measurements of plasma and cerebrospinal fluid 1,5-AG concentrations in addition to HbA1c concentration are useful for the forensic diagnosis of postmortem diabetes mellitus including fulminant type 1 diabetes, and it is better to apply the measurement of cerebrospinal fluid 1,5-AG concentration in those who died because of drowning.

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