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Validity of Postmortem Glycated Hemoglobin to Determine Status of Diabetes Mellitus in Corneal Donors

Soper, Mark C. BS, CEBT*; Marcovina, Santica M. PhD, DSc; Hoover, Caroline K. MBA, CEBT; Calhoun, Peter M. MA§; McCoy, Kristen E. CEBT, CTBS; Stoeger, Christopher G. MBA, CEBT; Schmidt, Gregory A. BS, CEBT**; Arafah, Baha M. MD††; Price, Marianne O. PhD‡‡; Szczotka-Flynn, Loretta B. OD, PhD‡‡,§§,¶¶; Lass, Jonathan H. MD§§,¶¶,‖‖

doi: 10.1097/ICO.0000000000001211
Clinical Science

Purpose: To examine the stability of postmortem glycated hemoglobin (HbA1c) measurement and its relationship to premortem glycemia.

Methods: Postmortem blood samples were obtained from 32 donors (8 known diabetic) and shipped on ice to a central laboratory to examine the stability of HbA1c measurements during the first 9 postmortem days. Thirty-nine other suspected diabetic donors underwent comparison of premortem and postmortem HbA1c measurements.

Results: Postmortem HbA1c measurements remained stable after 9 postmortem days (all measurements within ±0.2% from baseline with a mean difference of 0.02% ± 0.10%). Of the premortem measurements obtained within 90 days before death, 79% were within ±1.0% of the postmortem measurements compared with 40% for measurements more than 90 days apart. Three of the postmortem HbA1c measurements exceeded 6.5% (considered a threshold for diabetes diagnosis), although the medical histories did not indicate any previous diabetes diagnosis.

Conclusions: Postmortem HbA1c testing is feasible with current eye bank procedures and is reflective of glycemic control of donors during 90 days before death. HbA1c testing could potentially be a useful adjunct to review of the medical history and records for donor assessment for endothelial keratoplasty suitability and long-term graft success.

*Indiana Lions Eye Bank, Indianapolis, IN;

Department of Medicine, University of Washington and the Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, WA;

SightLife, Seattle, WA;

§Jaeb Center for Health Research, Tampa, FL;

Eversight Illinois, Chicago, IL;

Lions VisionGift, Portland, OR;

**Iowa Lions Eye Bank, Iowa City, IA;

††Department of Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH;

‡‡Cornea Research Foundation of America, Indianapolis, IN;

§§University Hospitals Eye Institute, Cleveland, OH;

¶¶Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, OH; and

‖‖Eversight Ohio, Cleveland, OH.

Reprints: Jonathan H. Lass, MD, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106 (e-mail:

Supported by Research to Prevent Blindness, Inc. (J.H.L.).

The authors have no conflicts of interest to disclose.

Received January 13, 2017

Received in revised form February 27, 2017

Accepted March 01, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.