Evaluation of 1, 5-anhydro-d-glucitol in clinical and forensic urine samples. (June 2018)

• Record Type: Journal Article
• Authors: Sydow, Konrad; Wiedfeld, Christopher; Musshoff, Frank; Madea, Burkhard; Tschoepe, Diethelm; Stratmann, Bernd; Hess, Cornelius
• Is Part Of: Forensic science international. Volume 287(2018)
• Page Start: 88
• Page End: 97
• Publication Date: 2018-06
• Subjects: 1, 5-Anhydro-d-glucitol -- Post mortem -- Ante mortem -- Urine -- LC–MS/MS -- Diabetes mellitus; Medical jurisprudence -- Periodicals; Chemistry, Forensic -- Periodicals; Forensic Medicine -- Periodicals; Médecine légale -- Périodiques; Chimie légale -- Périodiques; Gerechtelijke geneeskunde; Gerechtelijke chemie; Gerechtelijke psychiatrie; Chemistry, Forensic; Medical jurisprudence; Electronic journals; Periodicals; Electronic journals; 614.1
• DOI: 10.1016/j.forsciint.2018.03.002
• Languages: English
• ISSNs: 0379-0738

Abstract

Highlights: Full validation of a APCI-LC–MS/MS method for quantitation of 1, 5-AG in urine. Low concentrations of 1, 5-AG in urine indicates an ante mortem existing diabetes. Deceased due to diabetic coma showed lower urinary 1, 5-AG values than control group. Abstract: Because of the lack of characteristic morphological findings post mortem diagnosis of diabetes mellitus and identification of diabetic coma can be complicated. 1, 5-Anhydroglucitol (1, 5-AG), the 1-deoxy form of glucose, competes with glucose for renal reabsorption. Therefore low serum concentrations of 1, 5-AG, reflect hyperglycemic excursions over the prior 1–2 weeks in diabetic patients. Next to clinical applications determination of 1, 5-AG can also be used in forensic analysis. To investigate the elimination of 1, 5-AG, a liquid chromatographic–mass spectrometric method for the determination of 1, 5-AG and creatinine in urine was developed and validated according to international guidelines. To evaluate ante mortem concentrations of 1, 5-AG spot urine samples of 30 healthy subjects, 46 type 1 and 46 type 2 diabetic patients were analyzed. 1, 5-AG urine concentrations of diabetic patients were significantly (p < 0.001) lower (mean: 1.54 μg/ml, n = 92) compared to concentrations of healthy subjects (mean: 4.76 μg/ml, n = 30) which led to the idea that 1, 5-AG urine concentrations post mortem might help in the interpretation of a diabetic coma post mortem. Urine of 47 deceased non-diabetics, 37 deceased diabetic and 9 cases of diabetic coma were measured. Comparison of blood and urine 1, 5-AG concentrations in clinic samples (linear, R 2 = 0.13) and forensic samples (linear, R 2 = 0.02) showed no correlation. Urinary levels of 1, 5-AG in deceased diabetic (mean 6.9 μg/ml) and in non-diabetic patients (mean 6.3 μg/ml) did not show a significant difference (p = 0.752). However, urinary 1, 5-AG concentrations in deceased due to diabetic coma (mean: 1.7 μg/ml) were significantly lower than in non-diabetic (mean: 6.3 μg/ml, p = 0.039) and lower than in diabetic cases (mean: 4.7 μg/ml, p = 0.058). The determination of a reliable cut-off for the differentiation of diabetic to diabetic coma cases was not possible. Normalization of urinary 1, 5-AG concentrations with the respective creatinine concentrations did not show any gain of information. In clinical (serum) and forensic blood samples a significant difference between all groups could be detected (p < 0.05). Comparison of blood and urine 1, 5-AG concentrations in clinical samples (linear, R 2 = 0.13) and forensic samples (linear, R 2 = 0.02) showed no correlation.