• Users Online: 454
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 34-37

A study of serum magnesium level in type 2 diabetes mellitus and its association with glycemic control and its complications


1 Department of General Medicine, SBKS MIRC, Sumandeep Vidyapeeth, Piparia, India
2 Department of Medicine, PIMSR, Parul University, Waghodia, Vadodara, Gujarat, India

Date of Submission04-Aug-2020
Date of Decision07-Dec-2020
Date of Acceptance02-Feb-2021
Date of Web Publication21-Apr-2021

Correspondence Address:
Dr. Arti Muley
Department of General Medicine, SBKS MIRC, Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jncd.jncd_53_20

Rights and Permissions
  Abstract 


Context: Diabetes is a major public health problem with increasing morbidity due to complications. There have been reports regarding the association of serum magnesium (S. Mg) with diabetic complications but they are few and inconclusive.
Aims: The aim was to find the status of S. Mg in patients of type 2 diabetes mellitus (type 2 DM) and study association of S. Mg with glycemic control and diabetic complications.
Settings and Design: This was a cross-sectional observational study carried out in a tertiary care hospital in rural area.
Subjects and Methods: All patients of type 2 DM were included. Detailed history was taken and all were subjected to routine investigations and S. Mg level. Patients were also screened for complications of diabetes.
Statistical Analysis Used: Data were analyzed for any association between S. Mg levels and diabetic control (hemoglobin A1c [HbA1c]) and also for the correlation with diabetic retinopathy and nephropathy.
Results: Mean S. Mg was significantly less in patients having uncontrolled diabetes (HbA1c ≥7%) as compared to those with HbA1c <7% (78.8% vs. 21.2%; P = 0.001). There was a negative correlation between S. Mg and HbA1c (r = −0.499; P = 0.001). We also found a statistically significant association of hypomagnesemia with retinopathy (odds ratio [OR] = 4.871; P = 0.001) and nephropathy (OR = 5.4; P = 0.001).
Conclusions: Hypomagnesemia is associated with uncontrolled HbA1c and diabetic complications. Routine monitoring and correction of S. Mg levels in type 2 diabetes patients may help in better control of HbA1c and delaying progression to retinopathy and nephropathy.

Keywords: Complications, glycemic control, serum magnesium, type 2 diabetes mellitus


How to cite this article:
Moradiya K, Muley A. A study of serum magnesium level in type 2 diabetes mellitus and its association with glycemic control and its complications. Int J Non-Commun Dis 2021;6:34-7

How to cite this URL:
Moradiya K, Muley A. A study of serum magnesium level in type 2 diabetes mellitus and its association with glycemic control and its complications. Int J Non-Commun Dis [serial online] 2021 [cited 2021 May 10];6:34-7. Available from: https://www.ijncd.org/text.asp?2021/6/1/34/314210




  Introduction Top


Type 2 diabetes makes 90% of diabetes cases.[1] Its worldwide prevalence may be 439 million by 2030.[2] According to the International Diabetes Federation and WHO, its prevalence is 10%[3] and over 19% of world's diabetics are Indians.[4]

Magnesium is an essential mineral found in dietary fibers, nonstarchy vegetables, fruits, nuts, and dairy products.[5] Hypomagnesemia has been reported in 25%–38% of type 2 diabetics[6] and to be associated with increased morbidity and mortality.[7],[8] However, most reports are inconclusive.[9],[10],[11] Hence, hypomagnesemia in diabetes is frequently overlooked.[12] This study was performed to find association of S. Mg with diabetic control and complications.


  Subjects and Methods Top


This was an observational cross-sectional study, carried out for 1½ year, from October 2017 to March 2019 after obtaining clearance from institutional ethical committee. All already diagnosed cases of type 2 diabetes mellitus (type 2 DM) and who were diagnosed at admission were enrolled. Patients with type 2 DM of age 18 years and above, who gave written informed consent, were included in the study. Patients receiving diuretics, those with chronic diarrhea, malabsorption syndrome, sepsis and those who were not willing to participate in the study were excluded.

Type 2 DM was diagnosed based on the diagnostic criteria given by the American Diabetes Association.[13] Diabetic retinopathy (DR) was diagnosed based on fundus Examination.[14] Diabetic nephropathy (DN) was diagnosed based on the presence of macroalbuminuria or microalbuminuria. Microalbuminuria was defined as an Albumin to creatinine ratio (ACR) between 30 and 300 mg/g. Macroalbuminuria was defined as an ACR >300 mg/g.[15] Diabetic neuropathy was diagnosed based on the presence of clinical features such as tingling and numbness. Xylidyl blue colorimetric method was used to estimate serum magnesium (S. Mg) level.[16] It was considered to be normal if in the range of 1.8–2.6 mg/dl. Less than 1.8 mg/dl was considered as hypomagnesemia.

Detailed history was taken from the subjects and examination was done to diagnose micro vascular complications of diabetes. Laboratory investigations were done to support the findings of examination. All patients were examined for complete blood count, urine routine and for microalbuminuria, fasting blood glucose, post prandial blood glucose, hemoglobin A1c (HbA1c), blood urea, serum creatinine, S. Mg, ultrasonography abdomen, and fundus examination. Other examinations such as electrocardiography, 2D echocardiography, serum sodium, and potassium were done as per the indication.

Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 24.0, IBM. Pearson correlation coefficient was used to find correlation of S. Mg level with diabetic control. Odds ratio was calculated to find association of S. Mg level with DR and also to find association of S. Mg level with diabetic nephropathy.


  Results Top


Total 138 patients were included. Eighty-seven patients (63.00%) were in the age group of 41–60 years, 28 (20.30%) were in age group of 19–40 years, whereas 23 (16.70%) were between 61 and 80 years. Eighty-four (60.90%) were male and 54 (39.10%) were female. Thus, there was male preponderance. Sixty-six (47.82%) were diabetic since 11–20 years, 44 (31.88%) were diabetic since 0–10 years, 23 (16.67%) were diabetic since 21–30 years, while 5 (3.62%) were diabetic since >30 years.

Fifty-two (37.68%) had S. Mg + 2 <1.8 mg% while 86 (62.32) had normal S. Mg+2 (>1.8 mg %). Mean value of S. Mg+2 was 1.56 ± 0.09 and 2.07 ± 0.23 in hypomagnesemic and normomagnesemic patients, respectively. Laboratory reports revealed that there was significant difference in mean total leukocyte count, Serum glutamic pyruvic transaminase (SGPT), serum glutamic-oxaloacetic transaminase (SGOT), K+, Randon blood sugar (RBS), and HbA1c between hypomagnesemia patients compared to normomagnesemia patients (P < 0.05) There was no significant difference in other laboratory values between the two groups [Table 1].
Table 1: Laboratory reports of the study population

Click here to view


The prevalence of hypomagnesemia in patient with HbA1c <7% was 21.2% as compared to that of normomagnesemia (61.3%), while the prevalence of hypomagnesemia in patient with HbA1c >7% was 78.8% as compared to that of normomagnesemia (38.4%). This difference of S. Mg level in relation to HbA1c was statistically highly significant (P ≤ 0.001) [Table 2].
Table 2: Status of magnesium level according to hemoglobinA1C

Click here to view


The incidence of PDR in hypomagnesemia patients was 13.5% as compared to 4.7% among patient having normal magnesium level. There was a statistically significant association between hypomagnesemia and Proliferative diabetic retinopathy (PDR). (P = 0.064; odds ratio [OR] = 3.189). Incidence of Non proliferative diabetic retinopathy (NPDR) in hypomagnesemia patients was 59.6% as compared to 23.3% among patient having normal magnesium level. There was strong significant association between hypomagnesemia and NPDR (P = 0.001; OR = 4.871). Incidence of nephropathy in hypomagnesemia patients was 25% as compared to 5.8% among patient having normal magnesium level. There was strong significant association between hypomagnesemia and nephropathy (P = 0.001; OR = 5.4) [Table 3].
Table 3: Association of diabetic complications with serum magnesium levels

Click here to view



  Discussion Top


The present study was undertaken with an aim to study S. Mg levels in type 2 DM patients coming to our hospital and to find if there is any association of S. Mg levels with diabetic complications and glycemic control. Magnesium plays an important role in the carbohydrate metabolism, it regulates rate-limiting enzymes involved in glycolysis, glucose homeostasis, and insulin action including both insulin receptor responses (tyrosine kinases) and the insulin-signaling cascade. Magnesium also regulates cellular glucose metabolism and insulin secretion. Other metabolic processes involving magnesium as a cofactor or directly are lipid metabolism, and protein and nucleic acid synthesis. Magnesium also has a stabilizing role for proteins, nucleic acids, and biological membranes.[17] Due to involvement in multiple metabolic functions, Mg may be an important factor in occurrence of complications.

We observed that 52 patients out of total 138 (37.68%) had S. Mg <1.8 mg % while 86 patients (62.32%) had normal S. Mg level. Some other previous studies have also reported hypomagnesemia in 30% to 55% of their study population.[18],[19],[20],[21],[22] One study by Heba et al.[23] reported hypomagnesemia in almost 80% of their study population of type 2 DM patients. The high prevalence of hypomagnesemia in their study population may be because they had included patients with type 2 diabetes of at least 5 years' duration. Another study by Saeed et al.[24] done in Iraq reported only 5% prevalence of hypomagnesemia in diabetics. This very low prevalence as compared to other studies may probably be due to race or dietary differences.

We found that significantly higher proportion (78.8%) of patients having HbA1c ≥7% had hypomagnesemia as compared to those having HbA1c <7% in which 21.2% had hypomagnesemia. In addition, there was a significant negative correlation between S. Mg and HbA1c level (r = −0.499, P = 0.001), which is similar to study by Aksit et al.[25] (r = 0.332, P < 0.001 respectively) and Yossef et al.[23] (r = 0.569, P < 0.0001 respectively). In other studies, Wahid et al.[26] and Kumar et al.[18] reported significant difference in HbA1c values of diabetics with low and normal magnesium levels.(P < 0.0001). Hence, there is a significant negative correlation of magnesium levels with HbA1c, however, the effect of Mg supplementation on glycemic control and bringing down HbA1c toward optimal remains to be seen which may be a topic for future research.

We found that odds of NPDR were significantly higher in patients with low magnesium levels. Similar observations were reported by Kumar et al.[19] who studied total 250 patients with type 2 DM and observed that 62.7% patients had NPDR and 21.8% had PDR. Odds of finding nephropathy were also significantly higher in patients with hypomagnesemia as compared to those with normal magnesium levels. Similar findings were reported by Arpaci et al.,[27] Corica et al.,[28] and Corsonello et al.[29] who found that diabetic patients with microalbuminuria or clinical overt proteinuria showed a significantly low S. Mg compared to normoalbuminuria group. However, no significant difference was observed in odds of finding hypomagnesemia among patients with neuropathy as compared to those without (P > 0.05).


  Conclusions Top


Better studies with larger sample size and study design like RCTs will aid in forming proper guidelines regarding status of magnesium levels in type 2 diabetes mellitus patients. However, from this study, we can say that low S. Mg level in type 2 diabetes patients may be associated with higher HbA1c level, higher incidence of retinopathy and nephropathy. Routine monitoring and correcting S. Mg levels in type 2 diabetes patients may help in better control of HbA1c and delaying progression to retinopathy and nephropathy.

Ethical approval statement

The study was started after getting approval from Institutional ethics committee.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
González EL, Johansson S, Wallander MA, Rodríguez LA. Trends in the prevalence and incidence of diabetes in the UK: 1996-2005. J Epidemiol Community Health 2009;63:332-6.  Back to cited text no. 1
    
2.
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87:4-14.  Back to cited text no. 2
    
3.
World Health Organization. Global Report on Diabetes. Diabetes Country Profiles. 2016. Geneva: WHO; 2016.  Back to cited text no. 3
    
4.
Nolan CJ, Damm P, Prentki M. Type 2 diabetes across generations: From pathophysiology to prevention and management. Lancet 2011;378:169-81.  Back to cited text no. 4
    
5.
Dall TM, Narayan KM, Gillespie KB, Gallo PD, Blanchard TD, Solcan M, et al. Detecting type 2 diabetes and prediabetes among asymptomatic adults in the United States: Modeling American Diabetes Association versus US Preventive Services Task Force diabetes screening guidelines. Popul Health Metr 2014;12:12.  Back to cited text no. 5
    
6.
de Lordes Lima M, Cruz T, Pousada JC, Rodrigues LE, Barbosa K, Canguçu V. The effect of magnesium supplementation in increasing doses on the control of type 2 DM. Diabetes Care 1998;21:682-6.  Back to cited text no. 6
    
7.
Curiel-Garc´ıa JA, Rodr´ıguez-Mor´an M, Guerrero-Romero F. Guerrero-Romero F. Hypomagnesemia andmortality in patients with type 2 diabetes. Magnes Res 2008;2:163-6.  Back to cited text no. 7
    
8.
Rodr´ıguez-Mor´an M, Guerrero-Romero F. Low serum magnesium levels and foot ulcers in subjects with type 2 diabetes. Arch Med Res 2001;32:300-3.  Back to cited text no. 8
    
9.
Tu YF, Yu HY, Li LX. Association between serum magnesium level and 24-hour urinary albumin level in patients with type 2 diabetes mellitus. Chin Gen Pract 2012;15:751-4.  Back to cited text no. 9
    
10.
Takagi H, Kobayashi Y, Taguchi O, Takei Y, Sumida Y. Influence of dietary intake of fish oil, magnesium, and zinc on metabolic parameters among individuals tested for diabetes. Nutrition 2015;31:988-93.  Back to cited text no. 10
    
11.
Fu YY, Chen XY, Zhang H, Huang XC, Yu ZY. Relationship between different levels of blood glucose with lipid and different levels of nutrients in patients with type 2 diabetics. Acad J Guangzhou Med Coll 2012;40:5-8.  Back to cited text no. 11
    
12.
Hans CP, Sialy R, Bansal DD. Magnesium deficiency and diabetes mellitus. Curr Sci 2002; 83:1456-63.  Back to cited text no. 12
    
13.
Ta S. Diagnosis and classification of diabetes mellitus. Diabetes Care 2014;37:S81.  Back to cited text no. 13
    
14.
Sihota R, Tandon R. Disease of Retina. Parson's Disease of Eye. 22nd ed. Elsevier. India; 2015. p. 312.  Back to cited text no. 14
    
15.
KDOQI. Clinical practice guidelines and recommendations for diabetes and chronic kidney disease Am J Kidney Dis 2007;49 Suppl 2:S12-154.  Back to cited text no. 15
    
16.
Glasdam SM, Glasdam S, Peters GH. The importance of magnesium in the human body: A systematic literature review. Adv Clin Chem 2016;73:169-93.  Back to cited text no. 16
    
17.
Ratge D, Kohse KP, Knoll E, Wisser H. Colorimetric measurement of serum and urine magnesium with the Cobas Mira Analyzer. Fresenius J Anal Chem 1986;324:297.  Back to cited text no. 17
    
18.
Kumar P, Bhargava S, Agarwal PK, Garg A, Khosla A. Association of serum magnesium with type 2 diabetes mellitus and diabetic retinopathy. J Family Med Prim Care 2019;8:1671-7.  Back to cited text no. 18
[PUBMED]  [Full text]  
19.
Kumar CA, Kolli SG, Katta S, Katta S. Serum magnesium levels in type 2 diabetes patients and its relation with diabetic nephropathy. Int J Med Res Health Sci 2018;7:90-4.  Back to cited text no. 19
    
20.
Jamali AA, Jamali GM, Tanwani BM, Jamali AA, Tanwani Y, Jamali NM. Association of hypomagnesemia in type 2 diabetic patients with and without peripheral neuropathy. J Diabetes Mellit 2018;8:27.  Back to cited text no. 20
    
21.
Saproo N, Singh R. Study of serum magnesium levels in diabetes mellitus and its correlation with complications (retinopathy and HbA1c) a cross-sectional study of one year. Int J Adv Med 2017;4:263-9.  Back to cited text no. 21
    
22.
Zhang Y, Li Q, Xin Y, Lv W, Ge C. Association between serum magnesium and common complications of diabetes mellitus. Technol Health Care 2018;26:379-87.  Back to cited text no. 22
    
23.
Yossef HM, Ghanem NS, Al-Jarhi UM, Shaker OG. Relation of serum magnesium level to microvascular complications and the components of metabolic syndrome in patients with type 2 diabetes mellitus. Egypt J Intern Med 2017;29:100.  Back to cited text no. 23
  [Full text]  
24.
Saeed H, Haj S, Qasim B. Estimation of magnesium level in type 2 diabetes mellitus and its correlation with HbA1c level. Endocrinol Diabetes Metab 2019;2:e00048.  Back to cited text no. 24
    
25.
Aksit M, Aksit MZ, Basok BI. Research article the impact of magnesium on glycemic regulation. Int J Med Biochem 2019;2:13-8.  Back to cited text no. 25
    
26.
Wahid A, Verma GC, Meena CP, Pathan AR. Study of serum magnesium level in patients with type 2 diabetes mellitus and it's correlation with glycosylated hemoglobin and diabetic complications. Int J Adv Med 2017;4:311-6.  Back to cited text no. 26
    
27.
Arpaci D, Tocoglu AG, Ergenc H, Korkmaz S, Ucar A, Tamer A. Associations of serum Magnesium levels with diabetes mellitus and diabetic complications. Hippokratia 2015;19:153-7.  Back to cited text no. 27
    
28.
Corica F, Corsonello A, Ientile R, Cucinotta D, Di Benedetto A, Perticone F, et al. Serum ionized magnesium levels in relation to metabolic syndrome in type 2 diabetic patients. J Am Coll Nutr 2006;25:210-5.  Back to cited text no. 28
    
29.
Corsonello A, Ientile R, Buemi M, Cucinotta D, Mauro VN, Macaione S, et al. Serum ionized magnesium levels in type 2 diabetic patients with microalbuminuria or clinical proteinuria. Am J Nephrol 2000;20:187-92.  Back to cited text no. 29
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   Abstract
  Introduction
  Subjects and Methods
  Results
  Discussion
  Conclusions
   References
   Article Tables

 Article Access Statistics
    Viewed98    
    Printed0    
    Emailed0    
    PDF Downloaded5    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]