Study of serum magnesium levels in diabetes mellitus and its correlation with complications (retinopathy and HbA1c) a cross-sectional study of one year
Keywords:Diabetes mellitus, Hypomagnesemia, HbA1c, Retinopathy
Background: Diabetes mellitus is a heterogeneous group of metabolic disorders characterized by chronic hyperglycemia with disturbance of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both. The aim of this study was to estimate serum magnesium levels in patients with type 2 diabetes mellitus and correlate it with complications of type 2 diabetes mellitus - glycemic control and retinopathy.
Methods: A cross-sectional study of 100 patients with type 2 diabetes, attending Government Medical College and associated Hospital, Jammu over a period of one year from 1st November, 2014 to 30th October, 2015. Detailed history including duration of diabetes, treatment mode, symptoms suggestive of retinopathy and associated diseases such as hypertension and ischemic heart disease were obtained, as per the proforma, followed by physical examination.
Results: Majority of patients (38%) of type-2 diabetes mellitus were in the age group of 51-60 years. Males constituting 71% with male to female ratio of 2.45:1. Complications were observed in 48 cases, which mainly included retinopathy 60.42% (all non-proliferative). Maximum patients (79%) had abnormal (>6.5%) glycosylated hemoglobin levels ranging from 6.5 to 12%. Patients with diabetic retinopathy had significantly higher prevalence of hypomagnesaemia compared to patients without retinopathy (58.62 % vs 18.31%).
Conclusions: Prevalence of hypomagnesaemia in type 2 diabetes was 30% in the present study. The present study illustrates that as the magnesium level decreases in type 2 diabetes mellitus patients, prevalence of retinopathy increases.
ADA (American Diabetes Association). Clinical Practice Recommendations. American Diabetes Associates. Diabetes Care. 2004;6:1-16.
International Diabetes Federation Diabetes Atlas. Available at www.idf.org/diabetesatlas. Accessed on 14 July 2016.
National diabetes fact sheet. Available at: http://www.diabetes.org/diabetes-statistics. Accessed on 14 July 2016.
Kim ES, Moon SD, Kim HS, Lim DJ, Cho JH, Kwon HS, et al. Diabetic peripheral neuropathy is associated with increased arterial stiffness without changes in carotid intimamedia thickness in type 2 diabetes. Diabetes Care. 2011;34(6):1403-5.
Frank B. Globalization of diabetes, the role of diet, lifestyle and genes. Diabetes Care. 2011;34(6):1249-57.
Daruka KM. Retinopathy in type 2 diabetes mellitus and serum magnesium levels. J Evid Med Healthcare. 2015;2(6):677-85.
Mooradian AD, Failla M, Hoogwerf, Maryniuk M, Wylie J. Selected vitamins and minerals in diabetes. Diabetes Care. 1994;17:464-79
Walter RM, Bhandarkar SD. Trace elements in diabetes mellitus. J Postgrad Med. 1981;27:129-32.
Baig MSA, Shamshuddin M, Mahadevappa KL, Attar AH, Shaikh AK. Serum magnesium as a marker of diabetic complications. J Evol Med Dental Sci. 2012;1(3):119-23.
Elin RJ. Assessment of magnesium status. Clin Chem. 1987;33:1965-70.
Gums JG. Clinical significance of magnesium: A review. Drug Intell Clin Pharm. 1987;21:240-6.
Chi TP, Mai TP, Son VP, Jaffrey MM, Thu T. Hypomagnesaemia in patients with type 2 diabetes. Clin Am Soc Nephrol. 2007;2:366-73.
Hans CP, Sialy R, Bansal DD. Magnesium deficiency and diabetes mellitus. Curr Sci. 2002;83:12.
Badyal A, Sodhi KS, Pandey R, Singh J. Serum magnesium levels: a key issue for diabetes mellitus. JK Science. 2011;13(3):132-4.
Grafton G, Baxter MA. The role of magnesium in diabetes mellitus. J Diabetes Complications. 1992;6:143-9.
Nadler JC, Malayan S, Luong H, Shaw S, Natarajan 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.
Sheehan JP. Magnesium deficiency and diabetes mellitus. Magnes Trace Element. 1992;10:215-9.
Mikhail N, Ehsanipoor K. Ionized serum magnesium in type 2 diabetes mellitus: Its correlation with serum magnesium and hemoglobin A1c levels. South Med J. 1999;92:1162-6.
Nasir H, Baradaran HR. Lipids in association with serum magnesium in diabetes mellitus patients. Bratisl Lek Listy. 2008;109(7):302-6.
Lefebvre PJ, Scheen AJ. Improving the action of insulin. Clin Invest Med. 1995;18:342-7.
Suarez A. Decreased insulin sensitivity in skeletal muscle of hypomagnesaemia rats. Diabetologia. 1993;36:82.
Laughlin MR, Thompson D. The regulatory rule for magnesium in glycolytic flux of the human erythrocyte. J Biol Chem. 1996;271:277-83.
WHO. Definition and Diagnoses of Diabetes, 2005. Available at http:// www.who.int/ diabetes/ publications/ Accessed on 17 august 2016.
Ghafour IM, Allan, Foulds WS. Common causes of blindness and visual handicap in the west of Scotland. Br J Ophthalmol. 1983;67(4):209-13.
Kahn HA, Hiller R. Blindness caused by diabetic retinopathy. Am J Ophthalmol. 1974;87(1):58-67.
Walti MK, Zimmermann MB, Spinas GA, Hurrell RF. Low plasma magnesium in type 2 diabetes. Swiss Med Wkly. 2003;133:289-92.
Antin SS, Kashinkunti M, Kataria AV, Dhananjaya M, Alevoor S. A cross sectional study of fasting serum magnesium levels in the patients with type 2 diabetes mellitus and its relation to diabetic complications. Sch J App Med Sci. 2014;2(2):502-6.
Kauser MM, Afreen A, Kumar SRV, Javarappa D. Study of serum magnesium in type 2 diabetes mellitus and its correlation with the modality of treatment – a south Indian study. Int J Med Sci Public Health. 2014;3(11):1398-1401.
Khubchandani AS, Sanghani H. Study of serum magnesium and HbAIc in diabetic patients along with changes in their lipid profiles. Indian J Clin Pract. 2013;23(11):11.
Gurjar P, Kumar S, Diwan SK, Patil MM. Serum magnesium in type 2 diabetes mellitus: Case-control study in rural teaching hospital. Inter J Analy Pharma Biomed Sci. 2014;3(6):97-105.
Kaur P, Bal BS, Kaur I, Singh G, Singh B. Correlation of severity of diabetic retinopathy with various risk factors. Int J Res Health Sci. 2014;2(2):473-9.
Chauhan KP, Haridas N, Patel C. A study of serum magnesium levels in diabetic retinopathy patients. Indian J Appl Res. 2013;3(5):482-4.
Mohanty SS, Pinnelli VBK, Murgod R, Das R. Evaluation of serum copper, magnesium and glycated haemoglobin in type 2 diabetes mellitus. Asian J Pharma Clin Res. 2013;6(2):188-90.
Mcnair P, Christiansen C, Madsbad S, Lauritzen E, Faber O, Binder C, et al. Hypomagnesemia a risk factor in diabetic retinopathy. Diabetes. 1978;27:1075-7.