Justy, Antony (2009) Hypomagnesemia in Diabetes Mellitus - Prevalence, Causes and Correlation with the Complications and Comorbidities of Diabetes Mellitus. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION Diabetes mellitus is a very common endocrinopathy, and occurs as a result of absolute or relative deficiency in insulin. It is one of the main threats to human health in the 21st century, being a leading cause of death. Several distinct types of DM exist and are caused by a complex interaction of genetic and environmental factors. Diabetes is associated with various microvascular, macrovascular, and metabolic complications. Hypomagnesemia has been proposed to be correlated to diabetes, its pathogenesis, complications and comorbidities. Studies have shown that the prevalence of hypomagnesemia among diabetics range from 13.5 to 47.7%. Magnesium being the fourth most abundant cation in the body plays an important role in over 300 enzymatic reactions. Thus magnesium deficiency has been proposed as a possible contributor to diabetic complications. Of note is the large body of evidence that shows a link between hypomagnesemia and reduction of tyrosine-kinase activity at the insulin receptor level, which may result in the impairment of insulin action and development of insulin resistance. There is also evidence that magnesium supplementation may be associated with reduction in the incidence of diabetes and diabetic complications and comorbidities. Although there are several studies in the literature both from the west and from India on the role of magnesium in diabetic complications, several aspects of association between the two are unclear. This study was undertaken to assess the prevalence of hypomagnesemia in our diabetic population, and to propose probable predictors for the same. AIM : To determine the prevalence and predictors of hypomagnesemia in the outpatient diabetic population at Christian Medical College Hospital, and to describe the association with diabetic complications and co-morbidities. OBJECTIVES : 1. To determine the prevalence of hypomagnesemia in type 2 diabetes mellitus. 2. To ascertain if there was a correlation between hypomagnesemia and the presence of microvascular and macrovascular complications of type 2 diabetes mellitus. 3. To correlate hypomagnesemia with comorbidities like hypertension and dyslipidemia. 4. To evaluate the possible mechanisms of hypomagnesemia in diabetes in particular urinary magnesium excretion, drug history, dietary and drinking water magnesium content. METHODOLOGY : Setting: The study was conducted among the patients presenting to the diabetic outpatient clinic run by the Department of Endocrinology of the Christian Medical College (CMC), Vellore, South India, which is a 2200 bedded tertiary care teaching hospital. Duration of Study: May 2007 to May 2008. Inclusion Criteria: 1. Diabetic patients who were ambulant and willing to complete a 24 hour urine and serum sample were included after informed consent. 2. Diabetics who were willing to follow up in future in the same outpatient clinic belonging to areas within a 50 km radius from the main hospital. Exclusion Criteria: 1. The patients who had not completed the investigations – serum magnesium and 24 hours urine magnesium. 2. Diabetics who were not willing to follow up in the same out patient clinic. RESULTS : A total of 138 diabetic patients were evaluated for the prevalence of hypomagnesemia between March 2008 and May 2008. All were diabetics who were attending the diabetic endocrine out patient clinic at the Christian Medical College Hospital (CMCH), Vellore. All of them had a complete evaluation for diabetic comorbidities and complications- both microvascular and macrovascular. Of these, 126 patients had given 24 hour urine urine magnesium samples, to look for inappropriate magnesuria. A careful dietary history was taken for about 20 of the patients and drinking water magnesium content was estimated in 4 of the hypomagnesemic and 6 normomagnesemic patients. All the patients who had low serum magnesium, were informed about their low serum magnesium levels via phone, and the need for supplementation. CONCLUSIONS : The important conclusions of this study are as follows: 1. The prevalence of hypomagnesemia in our diabetic population was detected to be 5.1% (CI- 1.43%- 8.77%). 2. The mean magnesium concentration in our diabetic population was 2.06+/-0.23 mg/dl. 3. All the 7 hypomagnesemic patients had HbA1c levels above 7 g%. 4. The mean HbA1c was higher in the hypomagnesemic group (8.98 g% +/- 1.37), than in the normomagnesemic group (8.30 g% +/- 1.75), though the difference was not statistically significant (p value-0.31). 5. Males had a higher mean magnesium concentration than females (2.1mg/dl in males and 2.02 mg/dl in females), with a p value 0.04. 6. The proportion of patients with retinopathy and neuropathy in the hypomagnesemics was higher than the normomagnesemic population, and the p values were approaching statistical significance (p 0.07 and 0.09 respectively). 7. The difference between the mean magnesium concentration between the patients with and without retinopathy, was also approaching statistical significance (p-0.08). 8. The profile of the microvascular- neuropathy, microalbuminuria and macrovascular complications between the hypomagnesemic and normomagnesemic diabetics were comparable, and there was no statistically significant difference. The mean magnesium concentration was also comparable between the groups with and without each of the micro and macrovascular complications. 9. The proportion of patients who had been on insulin was higher in the hypomagnesemic groups than the normomagnesemic group with a p value of 0.001. 10. The patients who had been on thiazolidinediones had a significantly lower magnesium concentration (1.91 mg/dl) compared to the patients who had not been on thiazolidinediones (2.07 mg/dl), p value was 0.04. 11. 24 hour urine magnesium excretion was almost within normal range among the hypomagnesemic patients. 12. There was no statistically significant difference in the urinary magnesium excretion between the diuretic users and diuretic non-users. 13. There was a significantly higher daily intake of magnesium in our population than in other studies averaging >400mg/day. It was higher in the normomagnesemic group- 430 mg/day, compared to 403 mg/day in the hypomagnesemic group, but the difference was not statistically significant. 14. The magnesium concentration of drinking water is higher in Vellore, in view of the tapwater being hardwater, on which most of our population depends, which could also explain the low prevalence of hypomagnesemia in our diabetic population. In summary, although hypomagnesemia is a potentially reversible metabolic problem in diabetes, it does not appear to be a significant problem in our diabetic population, when compared to the other studies from India and the west. The causes of this low prevalence could be probably due to the high magnesium content of drinking water, and high daily dietary intake of magnesium in our population. The other factors like the diabetic complications and co-morbidity profile of the hypomagnesemics and normomagnesemic groups were comparable, except for nephropathy and retinopathy which were approaching significance.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Hypomagnesemia ; Diabetes Mellitus ; Prevalence ; Causes ; Correlation ; Complications ; Comorbidities. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 16 Feb 2018 01:19 |
| Last Modified: | 16 Feb 2018 01:19 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5735 |
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