Importancia del estudio del humor vítreo para el diagnóstico de diabetes mellitus y cetoacidosis diabética post mortem. A propósito de un caso

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Abstract

Resumen La diabetes mellitus tipo 1 usualmente debuta con cetoacidosis, una de sus complicaciones que puede llevar a la muerte de forma rápida. Esta condición puede pasar inadvertida, requiriéndose la autopsia médico-legal. Dentro de las muestras de mayor interés en la autopsia se encuentra el humor vítreo, el cual se usa para detección de glucosa y electrolitos, entre otros. Presentamos el caso de una joven de 15 años de edad, sin antecedentes importantes, la cual fallece luego de presentar un cuadro de faringoamigdalitis y los hallazgos anatomopatológicos no permiten identificar la causa de la muerte. Sin embargo, el estudio de humor vítreo revela concentraciones elevadas de glucosa, y la química sanguínea muestra valores de acetona aumentados. Discutimos la importancia de la recolección del humor vítreo para el diagnóstico de enfermedades metabólicas.

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David Maahs, Nancy West, Jean M Lawrence … (2010)

This article describes the epidemiology of type 1 diabetes mellitus (T1D) around the world and across the lifespan. Epidemiologic patterns of T1D by demographic, geographic, biologic, cultural, and other factors in populations are presented to gain insight about the causes, natural history, risks, and complications of T1D. Data from large epidemiologic studies worldwide indicate that the incidence of T1D has been increasing by 2% to 5% worldwide and that the prevalence of T1D is approximately 1 in 300 in the United States by 18 years of age. Research on risk factors for T1D is an active area of research to identify genetic and environmental triggers that could potentially be targeted for intervention. Although significant advances have been made in the clinical care of T1D with resultant improvements in quality of life and clinical outcomes, much more needs to be done to improve care of, and ultimately find a cure for, T1D. Epidemiologic studies have an important ongoing role to investigate the complex causes, clinical care, prevention, and cure of T1D. Copyright 2010 Elsevier Inc. All rights reserved.

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Lifestyle and cardiometabolic risk in adults with type 1 diabetes: a review.

Anne-Sophie Brazeau, Catherine Marchand-Leroux, Irene Strychar … (2014)

Over the past decades, there has been a major upward shift in the prevalence of cardiometabolic risk (CMR) factors (central obesity, insulin resistance, hypertension and dyslipidemia) in patients with type 1 diabetes, which could have either an additive or a synergistic effect on risk for cardiovascular disease. These metabolic changes are occurring in parallel to the worldwide obesity epidemic and the widespread use of intensive insulin therapy. Poor lifestyle habits (poor diet quality, sedentary behaviours and smoking) are known to be driving factors for increased CMR factors in the general population. The objective of this review is to explore the lifestyle habits of adults with type 1 diabetes and its potential association with CMR factors. Evidence suggests that adherence to dietary guidelines is low in subjects with type 1 diabetes with a high prevalence of patients consuming an atherogenic diet. Sedentary habits are also more prevalent than in the general population, possibly because of the additional contribution of exercise-induced hypoglycemic fear. Moreover, the prevalence of smokers is still significant in the population with type 1 diabetes. All of these behaviours could trigger a cascade of metabolic anomalies that may contribute to increased CMR factors in patients with type 1 diabetes. The intensification of insulin treatment leading to new daily challenges (e.g. carbohydrates counting, increase of hypoglycemia) could contribute to the adoption of poor lifestyle habits. Preventive measures, such as identification of patients at high risk and promotion of lifestyle changes, should be encouraged. The most appropriate therapeutic measures remain to be established. Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

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Postmortem diagnosis of diabetes mellitus and its complications

Cristian Palmiere (2015)

Diabetes mellitus has become a major cause of death worldwide and diabetic ketoacidosis is the most common cause of death in children and adolescents with type 1 diabetes. Acute complications of diabetes mellitus as causes of death may be difficult to diagnose due to missing characteristic macroscopic and microscopic findings. Biochemical analyses, including vitreous glucose, blood (or alternative specimen) beta-hydroxybutyrate, and blood glycated hemoglobin determination, may complement postmortem investigations and provide useful information for determining the cause of death even in corpses with advanced decompositional changes. In this article, we performed a review of the literature pertaining to the diagnostic performance of classical and novel biochemical parameters that may be used in the forensic casework to identify disorders in glucose metabolism. We also present a review focusing on the usefulness of traditional and alternative specimens that can be sampled and subsequently analyzed to diagnose acute complications of diabetes mellitus as causes of death.