IJCRR

IJCRR - 9(4), February, 2017

Pages: 26-28

Date of Publication: 20-Feb-2017

Study of Serum magnesium levels in Type -2 Diabetes Mellitus

Author: Siddanagouda Biradar1, Shivraj Patil1, Deepak Kadeli1

Category: Healthcare

Abstract:Background The global burden of diabetes and its related complications is growing at an unprecedented level. India has the highest no of diabetics in the world. Various modalities of treatment are being explored to retard the progression of the disease apart from the traditional hypoglycemic agents. Newer theories have tried to link elements like magnesium and Vitamin D to the glucose metabolism. This study tries to associate deficiency of magnesium levels with the risk of diabetes mellitus. Objectives To compare the levels of serum magnesium in patients with type 2 diabetes mellitus and normal healthy individuals and a correlation of these values with the glycemic control. Materials and Methods It is an observational study done comparing the magnesium levels in 50 patients with diabetes with 50 matched healthy individuals. Results The mean FBS levels among cases and controls were 230. \?17.8 mg/dl and 99.42\?25.4 mg/dl respectively. The mean serum magnesium levels among diabetic group and control group were 1.67\?0.37 mg/dl and 2.03\?0.25 respectively, the difference being statistically significant (p< 0.01). Among the diabetic group the mean serum creatinine levels among those with controlled and uncontrolled group were 0.93\?0.56 mg/dl and 1.33\?0.29 mg/dl respectively. There was statistically significant (p< 0.01) difference between controlled and uncontrolled diabetes group with respect to serum creatinine levels. Conclusion This study revealed a definite lowering of serum magnesium in diabetic patients and the levels are inversely proportional to the level of glycemic control. Magnesium levels are further lower in patients with diabetic complications. Key words: Hypomagnesemia, diabetes mellitus, glycemic control

Keywords: Hypomagnesemia, Diabetes mellitus, Glycemic control

Full Text:

Introduction

There has been increased interest about the role of magnesium ion in the pathogenesis of diabetes mellitus particularly the progression of the disease. Studies have associated hypomagnesaemia occurring at an increased frequency among patients with diabetes Mellitus compared with their counterparts without diabetes. Although diabetes is known to induce hypomagnesaemia, magnesium deficiency has also been proposed as a risk factor for diabetes mellitus type 2. Lower than normal levels of magnesium occurs at an incidence of 13.5 to 47.7% among diabetes patients. Hypothesis explaining this deficiency include  decreased dietary intake, altered insulin metabolism, glomerular hyperfiltration, osmotic diuresis, autonomic dysfunction, recurrent metabolic acidosis, hypophosphatemia, and hypokalemia. In diabetics  hypomagnesaemia is more commonly linked to those subset who have poor control of sugars, atherosclerotic arteries specifically coronary arteries, hypertension, micro and macro vascular complications like diabetic retinopathy, nephropathy, neuropathy, and foot ulcerations. It has been postulated that the increased incidence of hypomagnesaemia among diabetics is multifactorial.¹ many studies have suggested that magnesium supplementation has a beneficial effect on insulin action and glucose metabolism in diabetics.² Low serum magnesium levels have been reported in type 1 and type 2 diabetes mellitus regardless of the type of therapy.³

 To compare the levels of serum magnesium in patients with type 2 diabetes mellitus and normal healthy individuals and a correlation of these values with the glycemic control.

Materials and Methods

 The study was conducted in medical college hospital and research and research center in Vijayapur.A total of 50 cases of type-2 diabetes mellitus were included in the study after satisfying the inclusion and exclusion criteria. 50 non diabetic patients were included as controls.

 The inclusion criteria included patients diagnosed as diabetes mellitus as per WHO  criteria.Patients excluded from this study were those diabetics who had associated hypertension, gastrointestinal disorders, impaired renal function, alcoholism, pancreatitis, other endocrinal disorders, those on diuretic therapy  and aminoglycosides.

Fasting blood samples were collected for glucose levels. Serum magnesium and creatinine levels were also done in both groups of patients. Serum magnesium was measured by Calmagite endpoint method.^{4, 5}

The Data was analyzed using z test and chi square test.

Results

The mean age of the patients in diabetic group was 55.42±12.65 years whereas in controls it was 55.58±12.84 years.

Both among the cases and controls the sex distribution was same i.e. 62% males and 38% females. The maximum numbers of patients were in the age group of 41-50 years (42%).

The mean FBS levels among cases and controls were 230. ±17.8 mg/dl and 99.42±25.4 mg/dl respectively. The mean serum magnesium levels among diabetic group and control group were 1.67±0.37 and 2.03±0.25 mg/dl respectively (Table 1), the difference being statistically significant (p<0.01). Among the diabetic group the mean serum magnesium levels in that subset with uncontrolled diabetes were 1.45±0.34 compared to 1.59±0.16 in those with controlled diabetes. (Table 2)

Among the diabetic group the mean serum creatinine levels among those with controlled and uncontrolled group were 0.93±0.56 mg/dl and 1.33±0.29 mg/dl respectively. There was statistically significant (p<0.01) difference between controlled and uncontrolled diabetes group with respect to serum creatinine levels.

Discussion

Magnesium is a very important element for the human body. It is the fourth most abundant cation and the second most abundant intracellular cation after potassium. It serves as a cofactor in more than 300 enzymatic reactions mainly involving transfer of phosphate group. It is indispensible for maintaining neuromuscular excitability and has an important role in the maintenance of cardiac function.⁶ The ubiquitous nature of magnesium in a wide variety of cellular processes critical to glucose metabolism, insulin action and cardiovascular functions has been well studied.⁷ The incidence of subclinical magnesium deficiency is common in diabetes and cardiovascular disorders.⁸

Our observations revealed a definite lowering of serum magnesium in diabetic patients. These observations correlate well with previous studies.

Nagase N et al. studied the interrelationships between hypertension, ischemic heart disease and diabetes mellitus. They concluded that serum magnesium level of poorly controlled diabetic patients is lower than that of well controlled diabetic patients.⁹ Similar conclusions were also derived by Nadler JL et al.

The present study did not evaluate the interrelations between hypertension, ischemic heart disease but had similar results. All three studies showed lower serum magnesium levels in diabetics when compared to controls.

Dietary supplementation with magnesium in addition to classical therapies for diabetes may help in prevention or delaying of diabetic complication. Some studies have documented that oral magnesium supplementation improves insulin sensitivity and metabolic control in type 2 diabetics with lower serum magnesium levels.¹⁰ It has also been shown that it has beneficial effect on lipid profile of diabetic patients.

Conclusion

Consequently, we suggest hypomagnesaemia as a possible risk factor in development and progress of diabetic complications. Exact cause of diabetic hypomagnesaemia is still unknown but an increased urinary loss of magnesium may contribute to it.^{11, 12}

Acknowledgement

Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

The Authors declare no conflict of interest

Funding - Nil

Table 1 : Comparison between cases and controls

Table 2: Comparison between Controlled and uncontrolled diabetics

References:

1. Pham PC1, Pham PM, Pham SV, Miller JM, Pham PT.Hypomagnesemia in patients with type 2 diabetes.Clin J Am Soc Nephrol. 2007 Mar;2(2):366-73. Epub 2007 Jan 3.
2. Nadler JL, Malayan S, Luong H, Shaw S, Natrajan RD, Rude RK. Intracellular free magnesium deficiency plays a key role in increased platelet reactivity in type 2 diabetes mellitus. Diabetes Care 1992; 15: 835-41.
3. Riduara RL, Stamfer MJ, Willet WC, et al. Magnesium intake and risk of type 2 diabetes mellitus in men and women. Diabetes Care 2004; 27:134-140.
4. Glindler EM, Hetti DA. Colorimetric determination with bound ‘calmagite’ of magnesium is human blood serum. Clin Chem 1971;17:662.
5. Tietz NW. Textbook of Clinical Chemistry. 3rd edition, Burtis CA, Ashwood ER (Eds.), WB Saunders 1999:p. 1034-36, et. 1408-10.
6. Huerta MG, Holmes V F, Roemenich J N, et al. Magnesium deficiency is associated with insulin resistance in obese children. Diabetes Care 2005; 28: 1175-1181.
7. Jain AP, Gupta NN, Kumar A. Some metabolic facets of magnesium in diabetes mellitus. J Asso phys Ind 1976; 24:827-830.
8. Riduara RL, Stamfer MJ, Willet WC, et al. Magnesium intake and risk of type 2 diabetes mellitus in men and women. Diabetes Care 2004; 27:134-140.
9. Nagase N. Hypertension and serum magnesium in the patients with diabetes and coronary heart disease. Hypertens Res1996 ;19:65-68.
10. Lennon EJ, Lemann J Jr, Piering WF, Larson LS. The effect of glucose on urinary cation excretion during chronic extracellular volume expansion in normal man. J Clin Invest 1974;53(5):1424-33.
11. Rodriguez-Moran M, Guerrero-Romero F. Oral magnesium supplementation improves insulin sensitivity and metabolic control in type 2 diabetic subject: a randomized double-blind controlled trial. Diabetes Care 2003;(4):1147-52.
12. Linderman RD, Adler S, Yeingst MJ, Beard ES. Influence of various nutrients on urinary divalent cation excretion. J Lab Clin Med 1967;70(2):236-45.