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.