Prevalence of magnesium deficiency in patients with type 2 diabetes mellitus from infection over 10 years in Al-Diwaniyah City, Iraq

Introduction

Diabetes Mellitus Type 2 (DM2) is a serious disorder public health concern due to its rising prevalence and long-term morbidity and asymptomatic long-time [1] . Magnesium (Mg) is a vital mineral that plays a crucial role in numerous metabolic processes and is involved in the control of cellular metabolism. Nuts, leafy greens, and whole grains are considered vital sources of magnesium (Mg +2 ) [2] . According to a recent study, giving overweight individuals with insulin resistance magnesium supplements improved their response to insulin and fasting blood sugar levels [3] . Magnesium is an essential cofactor for a number of enzymes, including the sodiumpotassium ATPase pump and the enzymes involved in the release of insulin [4] . A deficiency of magnesium hinders the capacity of cells to protect themselves against oxidative damage. This, in turn, makes cells more susceptible to the oxidative stress that diabetes causes, which speeds up the development of conditions connected to diabetes. Thus, hypomagnesaemia may worsen type 2 diabetes, but research has also indicated that consuming magnesium supplements lowers the incidence of both diabetes type 2 and metabolic syndrome by decreasing insulin resistance [5] .

The magnesium ion is an essential cofactor for numerous enzymatic reactions involved in a wide range of metabolic processes, magnesium deficiency in type 2 diabetes mellitus and metabolic syndrome may have physiopathological and clinical significance. This deficiency may manifest as a latent subclinical magnesium deficiency rather than less common overt hypomagnesaemia. Magnesium is the most prevalent cellular divalent cation in the human body, but it is also the fourth most abundant mineral after calcium, sodium, and potassium as intracellular cations [6] . Magnesium is mostly found (98%), inside cells. In healthy settings, a dynamic balance between the intake of magnesium from food, intestinal absorption and excretion, renal excretion, bone storage, and the needs of different bodily tissues keeps serum levels (2% of the total) within a restricted rangem [7][8][9] . People with type 2 diabetes have higher blood glucose levels. Furthermore, the body may not be reacting to insulin as it usually does. It seems sense that low magnesium levels could exacerbate type 2 diabetes complications because magnesium is involved in the metabolism of glucose and insulin. Additionally, in certain type 2 diabetics, the kidneys frequently don't function entirely normally. It's possible that your body will eliminate more magnesium than it should due to the elevated glucose levels [10] . In this study, we will clarify the association between hypomagnesaemia and diabetes type 2 by focusing on the effects of Mg +2 .

Clinical manifestations of magnesium

Magnesium is a neuroprotective component in multiple cellular processes. Magnesium reduces the release of glutamate from vesicles in a physiological context, hence reducing the excessive activation of glutamate receptors [11] . Magnesium is essential for maintaining intracellular calcium homeostasis. Physiologically, there is a significant imbalance in the distribution of Ca 2+ on either side of the cell membrane. The electrochemical gradient is maintained by the transport mechanism and modulation of calcium permeability in biological membranes. Excessive stimulation of NMDA receptors can lead to a significant influx of calcium ions, resulting in an overload of calcium. Excessive calcium levels can subsequently trigger calciumdependent enzyme systems, generate reactive oxygen species, modify nuclear chromatin, degrade proteins, oxidize lipids, and induce neuronal cell death [12] . Clinical studies have linked magnesium deficiency to hyper excitability, sleeplessness, elevated diastolic blood pressure, and chronic fatigue syndrome. Serum magnesium deficiency in erythrocytes has been associated with both higher resting and stress blood pressure and coronary artery spasms [13,14] .

Patients and Methods

This cross-sectional study examined diabetes patients who visited AL-Diwaniyah teaching hospital and diabetic center lab as outpatients, namely from January 2024 to April 2024. The study aimed to include a total of 60 cases, consisting of 60 patients and 35 controls. The specimens were collected subsequent to obtaining a brief medical background from each subject. During the measurement of serum blood sugar and serum magnesium, we collected data on age, gender, weight, height, and the presence of diabetes mellitus as a medical condition. Our patients were divided into two groups: There were a total of 60 cases of diabetic patients, with 30 being male and 30 being female. Additionally, there were 35 cases of control patients.

Data collection

A total of 6 mL of venous blood was taken using a fully sterile procedure after fasting for at least 10 hours. Three milliliters of blood were distributed into EDTA tubes, while the remaining two milliliters were deposited into gel separator tubes. A mechanized method was utilized to ascertain the fasting blood sugar (F.B.S) using the sample enclosed in the EDTA tube. To acquire the serum, the gel separator tubes were placed inside a centrifuge and spun at a velocity of 3000 revolutions per minute for a period of 5 minutes. The Cobase 411 equipment was employed to quantify the concentration of Magnesium in the serum. Subsequently, a technician verified the outcomes. Serum Magnesium levels below 0.85 to 1.10 mmol/L were classified as insufficient. The patient's profile contained information on the length of infection, diabetes, and melite use. A worksheet was generated and all the data was stored.

Results

The symbols representing glucose levels were measured in order to assess its impact on individuals with type 2 diabetes, as shown in Table 1. Figure 3.1 displays the average ± Standard Deviation (SD) of serum glucose levels, measured in mmol/L, for both normal control subjects and patients with type 2 diabetes. The figure also includes biostatistical calculations and the results of a student t-test. There is a strong correlation between the levels of glucose in the blood of diabetic patients and the length of time they have had the disease. This correlation is observed in both patients who have had the disease for less than 10 years and those who have had it for more than 10 years, as indicated in Table 2 and Table 3. Additionally, a biostatistical calculation and t-test were conducted to compare the levels of magnesium in the blood of diabetic patients and healthy individuals. In contrast, there is no notable disparity between males and females in diabetes patients with type 2, as seen in the table. (4).

Statistical Analysis

All the data has been inputted onto an Excel spreadsheet. We shall utilize suitable statistical analysis methods to examine all of the data.

Discussion

The four main causes of hypomagnesaemia are related to the patient's environment and include decreased intake, gastrointestinal loss, renal loss, and subsequent to drugs [15,16] . A number of factors can lead to hypomagnesaemia in people with type 2 diabetes (T2DM), including insufficient intake, complications from the diabetes such as diarrhea and gastroparesis, increased glomerular hyperfiltration, renal magnesium loss, metabolic acidosis, glycosuria from osmotic diuresis, and impaired magnesium resorption in the kidneys as a result of insulin resistance related to diabetes [17, 18] glucose levels are the main factors influencing hypomagnesaemia, with a significant frequency of occurrence in diabetic patients. A growing body of research indicates that hypomagnesaemia is common in diabetic patients, however, the frequency varies depending on the study design. Hypomagnesaemia is mostly linked to advanced age, the duration of diabetes, Diabetic micro-and macrovascular problems, treatment features, and diabetes severity [19,20] . It should be noted the discovery that PPI use is common among diabetics with dyspeptic problems such as diabetic gastroparesis may not come as a surprise. Nonetheless, it is important to consider the use of PPI in people with diabetes and hypomagnesaemia, as indicated by the fact that half of the patients had both conditions. Compared to people with diabetes and hypomagnesaemia, the proportion of SGLT-2 inhibitor usage was found to be considerably greater in people with diabetes who had normal magnesium levels. The question of whether this is a coincidence or if using SGLT-2 inhibitors prevents hypomagnesaemia is raised by this discovery. Magnesium levels are marginally but considerably raised by SGLT-2 inhibitors, according to a meta-analysis of randomized controlled studies [21,22] . Out of 60 diabetic patients, the highest rate of serum magnesium deficiency was found in females and males with diabetes Mellitus type2 during a duration over 10 years as compared with patient less than 10 years. Magnesium levels were examined to evaluate its impact on persons with type 2 diabetes. Table number three. The figure displays the serum magnesium levels (mg/dl) of both type 2 diabetic patients and normal controls, along with the bio-statistical calculation and student t-test. (3) as mean ± SD.

When comparing type 2 diabetic patients to the control group, there is a highly significant drop in serum magnesium levels (p<0.0001).

As indicated by table (2) and Fig ( 2), there is a strong link between the serum magnesium levels in diabetic patients and the length of the disease in patients (duration <5) & (duration > 5) years On the other hand, as table (4) illustrates, there is no discernible variation in magnesium levels between male and female diabetic patients. The fasting blood sugar test is a reliable method for detecting diabetes diagnosis, although people with T2DM are most commonly affected by magnesium insufficiency. Individuals infected for a duration of ten years or more exhibit a pronounced and noteworthy insufficiency in their magnesium levels, as compared to those infected for less than ten years. Adhering to doctors' recommendations to take supplements will help prevent the gradual impact of magnesium deficiency on nerves and kidney illness, as well as enhance insulin function. In this investigation on patients with type 2 diabetes, it was observed that hypomagnesemia was associated with insufficient glycemic control and contributed to the development and progression of microvascular complications. According to this study, there is a significant incidence of hypomagnesaemia in people with diabetes, and measuring magnesium levels should be part of routine screening, particularly in those with diabetes who have been diagnosed with hypomagnesaemia in the past, are older, have had diabetes for a longer period of time, and have impaired glycemic control.

Conclusion

References

1. Abusalah MAH, Ashshi AM, Mohamed AM, Bani IA, Khormi H. Prevalence of type 2 diabetes mellitus in the general population of Saudi Arabia, 2000-2020: A systematic review and meta-analysis of observational studies. Saudi Journal of Medicine & Medical Sciences. 2023;11(1):1-10.
2. Freedman MR, Keast DR. White potatoes, including french fries, contribute shortfall nutrients to children's and adolescents' diets. Nutrition Research. 2011;31(4):270277.
3. Behers BJ, Noor T, Guarino M, Bistara V, Natsaranga A, Mathews C, et al. Vitamins and Minerals for Blood Pressure Reduction in the General, Normotensive Population: A Systematic Review and Meta-Analysis of Six Supplements. Nutrients. 2023;15(19):4223.
4. Gommers LMM, Hoenderop JGJ, Bindels RJM, De Baaij JHF. Hypomagnesemia in type 2 diabetes: A vicious circle? Diabetes. 2016;65(1):3-13.
5. Mohammadi H, Shamshirian A, Eslami S, Shamshirian D, Ebrahimzadeh MA. Magnesium sulfate attenuates lethality and oxidative damage induced by different models of hypoxia in mice. BioMed Research International. 2020;2020(1):2624734.
6. Barbagallo M, Veronese N, Dominguez LJ. Magnesium in aging, health and diseases. Nutrients. 2021;13(2):463.
7. Saris N-EL, Mervaala E, Karppanen H, Khawaja JA, Lewenstam A. Magnesium: an update on physiological, clinical and analytical aspects. Clinica Chimica Acta. 2000;294(1-2):1-26.
8. Barbagallo M, Gupta RK, Dominguez LJ, Resnick LM. Cellular ionic alterations with age: Relation to hypertension and diabetes. Journal of the American Geriatrics Society. 2000;48(9):1111-1116.
9. Barbagallo M, Dominguez LJ, Galioto A, Ferlisi A, Cani C, Malfa L, et al. Role of magnesium in insulin action, diabetes and cardio-metabolic syndrome X. Molecular Aspects of Medicine. 2003;24(1-3):39-52.
10. Pennington JAT, Hubbard VS. Nutrition education materials from the National Institutes of Health: development, review, and availability. Journal of Nutrition Education and Behavior. 2002;34(1):53-58.
11. Van den Bergh WM, Algra A, Rinkel GJ, Bruijninckx CM, Van Gijn J. Role of magnesium in the reduction of ischemic depolarization and lesion volume after experimental subarachnoid haemorrhage. Journal of Neurosurgery. 2002;97(2):416-422.
12. Parsons CG, Danysz W, Quack G. Glutamate in CNS disorders as a target for drug development: An update. Drug News Perspectives. 1998;11(9):523-569.
13. Deckert A, Winkler V, Paltiel A, Razum O, Becher H. Time trends in cardiovascular disease mortality in Russia and Germany from 1980 to 2007-are their migration effects? BMC Public Health. 2010;10:1-9.
14. Samadov BS, Jalilova FS, Jalilov FS. Analysis of the components of the collection of medicinal plant raw materials of Indian pomegranate. Редакційна колегія. 2022;43:5-12.
15. Gragossian A, Bashir K, Bhutta BS, Friede R. Hypomagnesemia. 2022. StatPearls. Treasure Island (FL): StatPearls Publishing; c2023.
16. Ehrenpreis ED, Jarrouj G, Meader R, Wagner C, Ellis M. A comprehensive review of hypomagnesemia. Disease-aMonth. 2022;68(2):101285.
17. Hamarshih M, Alkhateeb M, Almuhaisen G, Bataineh O, Al-Katib S. Hypomagnesemia and poor glycemic control among type 2 diabetic patients: A cross-sectional study. Indian Journal of Endocrinology and Metabolism. 2022;26(6):575-580.
18. Joy SS, George TP, Siddiqui K. Low magnesium level as an indicator of poor glycemic control in type 2 diabetic patients with complications. Diabetes & Metabolic Syndrome. 2019;13(2):1303-1307.
19. Rabeea IS, Al-Gburi K, Adnan I, Hasan B, Mohammed M, Mohammed M et al. Pattern and correlates of hypomagnesemia among subset of diabetes mellitus. Current Diabetes Reviews. 2020;16(4):364-369.
20. Ramadass S, Basu S, Srinivasan AR. SERUM magnesium levels as an indicator of status of Diabetes Mellitus type 2. Diabetes & Metabolic Syndrome. 2015;9(1):42-45.
21. Tang H, Zhang X, Zhang J, Li Y, Su Y, Yin J, et al. Elevated serum magnesium associated with SGLT2 inhibitor use in type 2 diabetes patients: A meta-analysis of randomised controlled trials. Diabetologia. 2016;59:2546-2551.
22. Adem Keskin, Recai Aci, Emine Altin and Utku Duran. Co-evaluation of magnesium and 25hydroxyvitamin D3 in predicting the severity of COVID-19 disease. Int. J. Adv. Biochem. Res. 2022;6(2):89-93. DOI: 10.33545/26174693.2019.v3.i1a.108