An Investigation of Diabetes Mellitus in Postmortem Human Remains

Diabetes mellitus is one of the most prevalent and significant metabolic diseases impacting modern human populations. The goal of this research is to explore several analytical methods to better appreciate how diabetes impacts the skeleton, and to determine if this effect can be recognized in postmortem remains. Anthropologists are tasked with elucidating the relationship between nutrition, metabolism, growth, development, and skeletal health. Diabetes represents a crucial point of interface between these factors. Furthermore, as the percentage of diabetics increases in the general population, so will their representation in forensic cases. This study will provide tools for identifying characteristics of diabetes in the postmortem material available to anthropologists.

Diabetes is a disease process that can alter the function of many tissues and systems. For these reasons, three analytical approaches were conducted including: blood serum protein analysis using ELISA, bone mineral density (BMD) scans with a dual-energy x-ray absorptiometry (DXA) scanner, and macroscopic osteological analysis. This study was completed employing a sample of 80 known skeletal donations and 20 blood samples from the William M. Bass Donated Skeletal Collection at the University of Tennessee, Knoxville.

Results indicated that pro-inflammatory biomarkers may be quantified in postmortem blood samples, and that diabetics showed slightly higher average concentrations of cytokines associated with diabetes and lower concentrations of those related to insulin sensitivity. Bone density analysis revealed that diabetics and non-diabetics significantly differ in BMD, but this relationship varies between the sexes. Female diabetics had consistently denser bones in all measured variables of the lower limb, and one-third of forearm variables. Results based on male data did not display a similar outcome, with little difference observed between male diabetics and non-diabetics. Analysis of skeletal pathologies identified a set of three osteological variables, concentrated in the feet, as having the highest discriminatory potential. An accuracy rate of 83% was achieved in classifying individuals into diabetic versus non-diabetic categories.