According to the hypothesis of Traub, also known as the 'formula of Traub', postmortem values of
glucose and
lactate found in the cerebrospinal fluid or vitreous humor are considered indicators of antemortem
blood glucose levels. However, because the
lactate concentration increases in the vitreous and cerebrospinal fluid after death, some authors postulated that using the sum value to estimate antemortem
blood glucose levels could lead to an overestimation of the cases of
glucose metabolic disorders with fatal outcomes, such as
diabetic ketoacidosis. The aim of our study, performed on 470 consecutive forensic cases, was to ascertain the advantages of the sum value to estimate antemortem
blood glucose concentrations and, consequently, to rule out fatal
diabetic ketoacidosis as the cause of death. Other biochemical parameters, such as blood 3-beta-hydroxybutyrate,
acetoacetate,
acetone, glycated haemoglobin and urine
glucose levels, were also determined. In addition, postmortem native CT scan, autopsy, histology, neuropathology and toxicology were performed to confirm
diabetic ketoacidosis as the cause of death. According to our results, the sum value does not add any further information for the estimation of antemortem
blood glucose concentration. The vitreous
glucose concentration appears to be the most reliable marker to estimate antemortem hyperglycaemia and, along with the determination of other
biochemical markers (such as blood
acetone and 3-
beta-hydroxybutyrate, urine
glucose and glycated haemoglobin), to confirm
diabetic ketoacidosis as the cause of death.