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Table of Contents
CORRESPONDENCE
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 186-188

Study of magnesium levels in patients with type 2 diabetes mellitus


1 Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
2 Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
3 Department of Endocrinology and Metabolism, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Date of Submission25-Feb-2020
Date of Acceptance28-Feb-2020
Date of Web Publication27-Oct-2020

Correspondence Address:
Kiranmayi S Vinapamula
Associate Professor, Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati 517 507, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCSR.JCSR_12_20

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How to cite this article:
Gundalapalli N, Vinapamula KS, Sarala S, Suresh V, Suchitra M M. Study of magnesium levels in patients with type 2 diabetes mellitus. J Clin Sci Res 2020;9:186-8

How to cite this URL:
Gundalapalli N, Vinapamula KS, Sarala S, Suresh V, Suchitra M M. Study of magnesium levels in patients with type 2 diabetes mellitus. J Clin Sci Res [serial online] 2020 [cited 2020 Nov 27];9:186-8. Available from: https://www.jcsr.co.in/text.asp?2020/9/3/186/298949



Diabetes mellitus and its associated complications are the significant causes of morbidity and mortality. Besides the metabolic disturbances, including those of carbohydrate, protein and lipid metabolism, type 2 diabetes mellitus (T2DM) is associated with altered micronutrient levels.[1] Magnesium, which is the fourth-most abundant cation in human beings, acts as the second messenger for insulin action[2],[3] and is known to influence the function of insulin, thus playing an important role in glucose homeostasis. Magnesium helps to maintain the insulin sensitivity of tissues, and studies have found that appropriate intake of magnesium lowers the risk of development of T2DM, although the optimal magnesium concentration which would help in the primary prevention of diabetes is yet to be defined clearly.[4] The relationship between magnesium and diabetes mellitus is found to be bidirectional. While hypomagnesaemia is considered as one of the risk factors for the development of T2DM,[5] patients with diabetes were reported to have magnesium deficiency.[6],[7] Diabetes mellitus is considered as the most common endocrine disorder associated with magnesium deficiency.[8]

In addition to its role in several major metabolic pathways, magnesium also regulates vascular tone, cardiac rhythm and platelet-activated thrombosis and exhibits atheroprotective effects.[9] Magnesium supplementation was shown to protect from progression of atherosclerosis in patients on hemodialysis.[10] Population-based studies have shown an inverse association between serum magnesium levels and carotid intima-media thickness (CIMT), which is a surrogate marker of subclinical atherosclerosis and a predictor of cardiovascular disease (CVD) risk.[5],[11] Therefore, in addition to being decreased in diabetes mellitus, low magnesium levels may further contribute to the complications associated with diabetes.[12] In this background, the present study was taken up to measure the serum Mg levels and to study its association with cIMT in patients with T2DM.

The present study was conducted at a tertiary care teaching hospital in South India and included fifty patients in the age group of 30–60 years diagnosed with T2DM as per the American Diabetes Association criteria.[13] Fifty age- and gender-matched apparently healthy individuals were included as controls. Diabetes patients were further classified into two groups of 25 each, based on CIMT value using a cut-off of 0.57 mm proposed by Mohan et al.[14] Diabetes patients with CIMT ≥0.57 mm were considered to be having subclinical atherosclerosis, and diabetes patients with CIMT <0.57 mm were regarded as without subclinical atherosclerosis. This study was approved by the Institutional Ethics Committee. Patients with malnutrition, history of diarrhoea, thyroid disorders, kidney diseases, cardiovascular and cerebrovascular diseases, malignancy, acute and chronic inflammation, known smokers and alcoholics, those on insulin therapy and supplementation with vitamins and those not willing to participate were excluded from the study. After obtaining consent, fasting venous blood samples were collected from all the individuals. Plasma was separated immediately, and plain samples were allowed to clot and then centrifuged at 2000 rpm for 15 min. The samples were stored at −80°C until biochemical analysis. Plasma glucose was measured by the glucose oxidase peroxidase method, and Mg was assayed by xylidol blue method using commercial kits on Beckman Olympus AU680 autoanalyser (Beckman Coulter, USA). Ultrasound examination of the carotids was carried out both in cases and controls using Sonoline G40 Diagnostic ultrasound system (Siemens Medical Solutions USA Inc., USA) by the same radiologist who was blinded to the clinical information. The comparison of parameters between controls and diabetes patients was done using the independent samples t-test. The comparison between multiple groups was done using the analysis of variance (ANOVA), followed by post-hoc analysis for pair-wise comparisons. The association between the variables was analysed using Pearson or Spearman's rank correlation analysis. Statistical analyses were performed using Microsoft Excel spread sheets and Statistical Package for the Social Sciences (SPSS) software for Windows version 16.0.

Patients with T2DM and healthy controls belonged to the similar age. Fasting blood sugar (FBS) and CIMT were significantly higher, whereas serum Mg was significantly lower in T2DM patients compared to healthy controls. Further analysis of diabetes patients classified based on CIMT values into patients without and with subclinical atherosclerosis showed that both groups of diabetes patients had significantly higher glucose levels compared to controls. However, the glucose levels were similar in patients with and without subclinical atherosclerosis. The mean serum Mg levels in both groups of diabetes patients were significantly lower than in controls. The levels, however, did not show a significant difference between the patients with and without subclinical atherosclerosis [Figure 1] and [Figure 2]. Correlation analysis revealed that serum Mg levels did not show statistically significant association with fasting glucose levels or CIMT values in diabetes patients (r = −0.051, P = 0.276 and r = 0.043, P = 0.771 for glucose and CIMT, respectively).
Figure 1: Serum magnesium levels in controls and patients with T2DM. T2DM = Type 2 diabetes mellitus

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Figure 2: Serum magnesium levels in controls and patients with diabetes mellitus. with and without SCA. T2DM = Type 2 diabetes mellitus; SCA = Subclinical atherosclerosis

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Mg, which is the second-most common intracellular cation after potassium, acts as a cofactor in various enzymatic reactions involving energy metabolism. The important role of Mg in a wide variety of cellular processes that are relevant to glucose metabolism, insulin action and cardiovascular functions has been well appreciated. In the present study, serum Mg levels were found to be statistically significantly lower in diabetes patients when compared to the controls (P < 0.001) [Figure 1]. Similar findings were observed in earlier studies.[6],[7] Mg depletion was observed in both intracellular and extracellular compartments in patients with diabetes mellitus.[15] The exact cause for hypomagnesaemia in diabetes mellitus is not known; however, several factors have been found to be responsible. Osmotic diuresis resulting in increased urinary loss of Mg is one of the mechanisms underlying hypomagnesaemia in diabetes. Other causes include decreased dietary intake, hyperglycaemia and insulin resistance.[12] Some studies[16],[17] did not document lower Mg levels in diabetes patients compared to controls. could not observe a significant difference in serum Mg levels in type 2 diabetes patients when compared to healthy controls. It was reported that magnesium levels were related to age, gender, duration and severity of diabetes and presence of complications.[18] The difference in the observations between studies could be due to the differences in the study population.[18]

Diabetes mellitus is an independent risk factor for CVD, mainly atherosclerosis. The measurement of CIMT is a simple, reliable and a non-invasive marker to detect subclinical atherosclerosis, which is the early stage of atherogenesis. The diabetes patients in the present study were further classified into two groups of 25 each, based on the cutoff value of CIMT derived by Mohan et al., in their study on rheumatoid arthritis patients.[14] Diabetes patients with CIMT <0.57 mm were free of subclinical atherosclerosis, whereas diabetes patients with CIMT ≥0.57 mm were considered as having subclinical atherosclerosis. Both groups of diabetes patients had significantly higher FBS and mean CIMT than controls. Serum Mg levels were significantly lower in both groups of diabetes patients when compared to controls. However, except for CIMT, none of the studied parameters showed a significant difference between diabetes patients with and without subclinical atherosclerosis.

In conclusion, the findings of the present study show that serum magnesium levels were significantly lower in patients with T2DM. The decreased levels could occur due to increased urinary losses, decreased dietary intake, chronic hyperglycaemia or the insulin-resistant state. Low sample size is a limitation of the present study which could be the reason for the insignificant correlation between magnesium and CIMT. Since recent times, dietary magnesium intake, as well as serum magnesium concentration, has received attention in cardiovascular health. Owing to its potential role in causing an increased cardiovascular risk, hypomagnesaemia in diabetes patients might further add to the risk of increased CVD in diabetes patients, thus necessitating the need for the evaluation of magnesium levels in these patients and initiating appropriate measures. Simple measures such as adequate dietary intake of magnesium along with other measures may help to prevent hypomagnesaemia and further complications that might be contributed by low magnesium levels in T2DM.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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