title: Risk Factors for Fatal Hyperglycaemia Confirmed by Forensic Postmortem Examination - A Nationwide Cohort in Sweden.
abstract: OBJECTIVE
  The aim of this study was to identify risk factors associated with confirmed fatal hyperglycaemia, which could predispose potentially preventable deaths in individuals on glucose lowering drugs.
  
  
  METHODS
  A retrospective register-based case-control study conducted on a nationwide cohort with individuals who died due to hyperglycaemia as determined by forensic postmortem examination, in Sweden August 2006 to December 2012. Vitreous glucose was used to diagnose hyperglycaemia postmortem. The forensic findings stored in the National Forensic Medicine Database were linked to nationwide registers. Cases that died due to confirmed hyperglycemia with dispensed glucose lowering drugs were identified and living controls with dispensed glucose lowering drugs were randomly selected in the Swedish prescribed drug register and matched on age and sex. Information on comorbidities, dispensed pharmaceuticals, clinical data and socioeconomic factors were obtained for cases and controls. Adjusted multiple logistic regression models were used to identify risk factors associated with fatal hyperglycaemia.
  
  
  RESULTS
  During the study period 322 individuals, mostly males (79%) with the mean age of 53.9 years (SD.± 14) died due to confirmed hyperglycaemia. Risk factors for fatal hyperglycaemia included; insulin treatment (OR = 4.40; 95%CI,1.96, 9.85), poor glycaemic control (OR = 2.00 95%CI,1.23, 3.27), inadequate refill-adherence before death (OR = 3.87; 95%CI,1.99, 7.53), microvascular disease (OR = 3.26; 95% CI, 1.84, 5.79), psychiatric illness (OR = 2.30; 95% CI,1.32, 4.01), substance abuse (OR = 8.85; 95%CI,2.34, 35.0) and/or living alone (OR = 2.25; 95%CI,1.21, 4.18).
  
  
  CONCLUSIONS
  Our results demonstrate the importance of clinical attention to poor glycaemic control in subjects with psychosocial problems since it may indicate serious non-adherence, which consequently could lead to fatal hyperglycaemia.
authors: Forensic Medicine Laboratory, Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.|MSD AB, Stockholm, Sweden.
authors: Lotta
authors: L
authors: Walz
authors: Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
authors: Anna K
authors: AK
authors: Jönsson
authors: Forensic Medicine Laboratory, Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.|Department of Forensic Medicine, National Board of Forensic Medicine, Stockholm, Sweden.
authors: Brita
authors: B
authors: Zilg
authors: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors: Carl Johan
authors: CJ
authors: Östgren
authors: Forensic Medicine Laboratory, Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
authors: Henrik
authors: H
authors: Druid
mesh_terms: D015331:Cohort Studies; D005554:Forensic Medicine; D006801:Humans; D006943:Hyperglycemia / Q000401:mortality*; D011180:Postmortem Changes; D012307:Risk Factors; D013548:Sweden