Glycated haemoglobin (HbA_1c) for postmortem diagnosis of diabetes

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 (HbA_1c), 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 HbA_1c. HbA_1c 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, HbA_1c 6.0%-6.4% (42-46 mmol/mol) was within 5.8% (n = 29), and HbA_1c result of ≥6.5% (48 mmol/mol) manifested in 3.8% (n = 19) of cases. The higher the age, the more cases with HbA_1c value ≥6.0% (42 mmol/mol) occurred. In the group of external causes of death (n = 348), the HbA_1c value of ≥6.5% (48 mmol/mol) HbA_1c occurred in four cases. The HbA_1c 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, HbA_1c was within the reference range. A negative correlation occurred between alcohol intoxication and HbA_1c value. A positive correlation between ALT and HbA_1c was found - the higher stage of liver damage correlated with the higher HbA_1c level.