An Analysis of The Morbidity and Mortality of Diabetes Mellitus in a Forensic Context

To investigate the spectrum of diseases seen in diabetes mellitus in a forensic context, all autopsy reports of diabetic individuals who presented to Forensic Science, South Australia (FSSA), over a 5‐year period from 2005 to 2009 were studied. The leading cause of death was cardiovascular disease (55.0%), followed by unnatural deaths (15.4%) and infections (9.4%). In type 1 diabetics, principal causes of death included cardiovascular disease (44.7%), acute metabolic complications (18.7%), unnatural deaths (17.9%), and infections (8.9%). However, frequencies of these diseases differed in type 2 diabetics, with cardiovascular events responsible for 56.6% of cases, followed by unnatural deaths (15.0%) and infections (10.9%). A larger number of male deaths were seen in all disease categories, except respiratory and gastrointestinal where the frequencies were similar to females. Cardiovascular disease was the leading overall cause of death across all ages except in those under the age of 30 where metabolic complications were more common.     

中药穴位注射治疗2型糖尿病周围神经病变临床观察

目的 观察中药穴位注射治疗2型糖尿病周围神经病变的临床疗效。方法 将70例2型糖尿病周围神经病变（diabetic peripheral neuropathy,DPN）患者随机分为对照组和治疗组,每组35例。在糖尿病常规治疗基础上,对照组加用弥可保治疗,治疗组在对照组基础上加用红花注射液穴位注射。治疗前、治疗4周后分别进行密西根州糖尿病周围神经病评分（Michigan diabetic neuropathy score,MDNS）。结果 治疗4周后,治疗组临床疗效优于对照组,差异有统计学意义（P＜0.05）。两组患者治疗后MDNS评分和症状、体征评分均较治疗前明显减少（P＜0.05）;两组MDNS评分和症状、体征评分差值比较,差异均有统计学意义（P＜0.05）。结论 中药穴位注射可以显著减少DPN患者MDNS评分和症状、体征评分,提高生活质量。     

复方葛根芩连汤治疗脾虚肝郁、痰瘀内阻型糖尿病合并非酒精性脂肪肝临床观察

目的 观察复方葛根芩连汤治疗脾虚肝郁、痰瘀内阻型2型糖尿病（type 2 diabetes mellitus,T2DM）合并非酒精性脂肪肝（non-alcoholic fatty liver disease,NAFLD）的临床疗效。方法 将60例患者分为对照组和治疗组,每组30例,在基础治疗的基础上,对照组采用非诺贝特治疗,治疗组予以复方葛根芩连汤治疗,治疗3个月后观察两组患者治疗前后中医证候评分,空腹血糖（fast plasma glucose,FPG）、糖基化血红蛋白A1c（glycosylated hemoglobin A1c,HbA1c）、空腹胰岛素（fasting insulin,FINS）、稳态模型胰岛素抵抗指数（homeostasis model assessment of insulin resistance,HOMA-IR）、总胆固醇（total cholesterol,TC）、三酰甘油（triglyceride,TG）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol,LDL-C）、高密度脂蛋白胆固醇（high-density lipoprotein cholesterol,HDL-C）水平,采用B型超声观察肝脏脂肪样变化情况。结果 与治疗前比较,两组患者治疗后中医证候评分,血清FPG、HbA1c、FINS、HOMA-IR、TC、TG、LDL-C水平均显著降低（P<0.05）,HDL-C水平显著升高（P<0.05）;治疗组治疗后中医证候评分以及血清FPG、HbA1c、FINS、HOMA-IR、TC水平降低值和HDL-C水平升高值均大于对照组（P<0.05）。治疗组治疗后肝脏B型超声分级较治疗前明显改善（P<0.05）,而对照组治疗前后B型超声分级比较,差异无统计学意义（P>0.05）。结论 复方葛根芩连汤治疗脾虚肝郁、痰瘀内阻型T2DM合并NAFLD的临床疗效确切。     

2型糖尿病脂代谢紊乱患者中医证型与血清同型半胱氨酸和胱抑素C关系

目的 探究2型糖尿病脂代谢紊乱的中医证型特点及其与冠心病预测因子血清同型半胱氨酸（homocysteine,Hcy）、胱抑素C（cystatinC,CysC）的关系。方法 共纳入300例2型糖尿病脂代谢紊乱患者,调查其中医证型,检测并比较各证型患者血清Hcy、CysC、空腹胰岛素（fastinginsulin,FINS）、空腹血糖（fastingplasmaglucose,FPG）和糖化血红蛋白A1c（glycosylatedhemoglobinA1c,HbA1c）及胰岛素抵抗指数（homeostasismodelassessmentofinsulinresistance,HOMA-IR）水平。结果 300例患者中,痰湿阻遏型、气阴两虚型、肝肾阴虚型、血瘀脉络型和脾肾阳虚型和其他证型的病例数分别105、84、34、39、12、16。各证型患者HbA1c和FPG比较,差异无统计学意义（P>0.05）;以血瘀脉络型患者Hcy、CysC和HOMA-IR水平为最高（P＜0.05,或P＜0.01）。结论 2型糖尿病脂代谢紊乱患者以痰湿阻遏型和气阴两虚证型最为常见,血瘀脉络型患者冠心病预测因子异常与胰岛素抵抗有关。     

耳针辅助治疗社区气阴两虚型2型糖尿50例

目的 观察耳针辅助治疗气阴两虚型2型糖尿病的临床疗效。〖JP2〗方法 将100例气阴两虚型2型糖尿病患者随机分为对照组和干预组,每组50例,对照组给予饮食和运动指导及降糖药口服,干预组辅以耳针治疗,疗程12周。治疗前后分别观察两组中医证候积分、空腹血糖（fasting plasma glucose,FPG）、餐后2 h血糖（2-hour postprandial glucose,2hPG）、糖化血红蛋白A1c（hemoglobin A1c,HbA1c）、三酰甘油（triacylglycerol,TG）、总胆固醇（total cholesterol,TC）、低密度脂蛋白（low-density lipoprotein）、体质量。〖JP〗结果 干预组中医证候疗效显著优于对照组;治疗12周末,干预组中医证候积分、FPG、2hPG、HbA1c、TC、TG、LDL均较治疗前显著降低（P<0.01）,而对照组上述指标与治疗前比较,差异均无统计学意义（P>0.05）。结论 耳针辅助治疗能明显改善糖尿病患者气阴两虚证候,调节血糖和血脂,减轻体质量。     

Renal Cortical Pallor—A Useful Macroscopic Marker for Metabolic Derangements at Autopsy

Renal cortical pallor was studied as a potential marker at autopsy of diabetic ketoacidosis in 23 cases, hyperglycemic nonketotic coma in eight cases, and alcoholic ketoacidosis in five cases (vitreous humor glucose level ≥11.1 mM; β‐hydroxybutyrate level ≥5 mM). Renal cortical pallor was noted on macroscopic examination in 10 of 23 cases of lethal diabetic ketoacidosis (43.5%), three of eight cases of fatal hyperglycemic nonketotic coma (37.5%), and in two of five cases of alcoholic ketoacidosis (40%). Histologic examination revealed basal vacuolization of renal tubular epithelial cells in 12 cases, Armanni–Ebstein lesions in 10, and osmotic nephrosis in three. Although renal cortical pallor did not appear to be a particularly sensitive marker for hyperglycemia or ketoacidosis, and did not correlate with the severity of these parameters, it may still represent a useful macroscopic marker for underlying metabolic conditions at autopsy and should therefore prompt measurement of vitreous humor glucose and β‐hydroxybutyrate levels.     

益气温阳康复法辅治2型糖尿病30例

目的：观察益气温阳康复法辅助药物治疗2型糖尿病的临床疗效。方法：60例患随机分为2组，治疗组30例，配合消渴丸选取相关的穴位进行补法针刺，温针灸及推拿治疗，3周为1疗程，对照组30例，单独应用消渴丸，服法及疗程同治疗组，结果：治疗组总有效率为90％，对照组总有效率为70％（P＜0．01）。治疗组与对照组比较，治疗后气虚，阳虚症状的复常率显提高（P＜0．05），两组在降低血糖及糖化血红蛋白方面无显差异（P＞0．05），结论：益气温阳康复法对药物治疗2型糖尿病有明显的辅助作用。     

Postmortem detection of isopropanol in ketoacidosis

Isopropanol (IPA) detected in deaths because of diabetic ketoacidosis (DKA) or alcoholic ketoacidosis (AKA) may cause concern for IPA poisoning. This study addressed this concern in a 15-year retrospective review of 260 deaths in which concentrations of acetone and IPA, as well as their ratios, were compared in DKA (175 cases), AKA (79 cases), and IPA intoxication (six cases). The results demonstrated the frequency of detecting IPA in ketoacidosis when there was no evidence of IPA ingestion. IPA was detectable in 77% of DKA cases with quantifiable concentrations averaging 15.1 ± 13.0 mg/dL; 52% of AKA cases with quantifiable concentrations averaging 18.5 ± 22.1 mg/dL; and in cases of IPA intoxication, averaging 326 ± 260 mg/dL. There was weak correlation of IPA production with postmortem interval in DKA only (r = -0.48). Although IPA concentrations were much higher with ingestion, potentially toxic concentrations were achievable in DKA without known ingestion.     

Basal renal tubular epithelial cell vacuolization and alcoholic ketoacidosis

Subnuclear renal tubular epithelial cell vacuolization is a marker for diabetic ketoacidosis. Whether it is because of hyperglycemia or of ketoacidosis is unclear. To examine the effect of ketoacidosis on renal cells in isolation, five cases of lethal alcoholic ketoacidosis without hyperglycemia were examined (vitreous humor β-hydroxybutyrate: 6.42-8.75 mM, mean 7.66 mM; and glucose: 0.1-4.2 mM, mean 1.46 mM). Microscopic examination of the kidneys revealed basal vacuoles in three cases (60%). Seven control cases with acute alcohol toxicity without ketoacidosis (blood alcohol: 0.18-0.43%, mean 0.31%; and β-hydroxybutyrate: 0.12-0.42 mM, mean 0.21 mM) did not have these changes. In this study, basal epithelial vacuolization was found only in cases with significant ketoacidosis. Although the numbers are small, the finding of basal renal tubular epithelial vacuolization in normoglycemic cases with elevated β-hydroxybutyrate levels provide further evidence that disordered lipid metabolism may be involved in the pathogenesis of this phenomenon.     

Postmortem vitreous Beta-hydroxybutyrate: interpretation in a forensic setting*

Abstract: Vitreous beta‐hydroxybutyrate (BHB) was retrospectively analyzed in 1795 forensic cases using the Pointe Scientific method. Comparison of vitreous BHB with vitreous glucose in 1781 of the cases showed moderately good correlation r = 0.731. Comparison with blood alcohol levels in 1561 of the cases showed no correlation r = ?0.053. Vitreous BHB was a marker of diabetic ketoacidosis when above 6.0 mM with a vitreous glucose over 200 mg/dL. It was an indicator (>50%) for alcoholic ketoacidosis when above 6.0 mM with a vitreous glucose below 200 mg/dL. Recommendations for interpretation of vitreous BHB: <0.4 mM normal; 0.41–1.2 mM slightly elevated, rarely (<1%) of concern; 1.21–2.0 mM moderately elevated, less rarely (2.5%) of concern; 2.01–6.0 mM significantly elevated, frequently of concern (12–48%); >6.0 mM usually (100% in this study) indicated life‐threatening conditions. Vitreous BHB was helpful evaluating cases with ketogenic conditions, especially diabetes and alcoholism.