Abstract

Background and objectives: Diabetes mellitus (DM) is a leading cause of death and disability world wide. Magnesium acts as a cofactor in glucose metabolism and its decreased level causes insulin resistance and many complications in diabetic patients. The present study evaluated the correlation of serum magnesium with HbA1c in DM patients.

Materials and methods: This cross sectional study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka from July 2016 to June 2017. A total number of 100 individuals with and without diabetes mellitus were included in the study. HbA1c was measured by high performance liquid chromatography and estimation of serum magnesium was done by automatic biochemistry analyzer.

Results: Out of 100 enrolled participants, 50 were diagnosed patients of DM (Group-A) and 50 were age and sex matched apparently healthy individuals (Group-B). The mean age of Group-A and B individuals was 50.5 ± 6.0 and 50.4 ± 5.1 years respectively. Group-A had significantly (p < 0.001) lower serum magnesium concentration compared to Group-B (1.5 ± 0.6 mg/dl vs 2.3 ± 0.5 mg/dl). Serum magnesium levels showed significant negative correlations with HbA1c (r = -0.511, p < 0.001).

Conclusion: DM patients showed significant negative correlation of serum magnesium with HbA1c level. Routine screening for serum magnesium status would be helpful for the better management of diabetic cases.

IMC J Med Sci. 2023. 17(1): 005. DOI: https://doi.org/10.55010/imcjms.17.005

*Correspondence: Farzana  Ahmed, Department of Biochemistry, Ibrahim Medical College, 1/A Ibrahim Sarani, Shegunbagicha, Dhaka, Bangladesh. Email: [email protected]

Introduction

World Health Organization (WHO) has reported alarming increase of diabetes mellitus (DM) globally. It has increased from 180 million in 1980 to 422 million in 2014 and during this period the prevalence of diabetes has almost doubled from 4.7% to 8.5% [1-3]. In diabetes mellitus, the metabolism of several minerals is altered resulting into various organ dysfunctions leading to increased morbidity and mortality of the diabetic patients. Trace elements like magnesium, zinc and copper are important for the normal growth and biological functions of the human body. In recent years the role of these minerals has been studied extensively in diabetes, autoimmune, neurological and psychiatric disorders [4-9].

Among the trace elements, magnesium (Mg) acts as a cofactor in the glucose transport mechanism of the cell and also plays an important role in glucose metabolism by acting as a cofactor of various enzymes involved at multiple steps in insulin secretion, binding and activity [10]. Magnesium deficiency decreases insulin sensitivity via alteration of the insulin receptor associated tyrosine kinase in type 2 DM patients [11]. Deficiency of magnesium has been implicated in insulin resistance, carbohydrate intolerance, dyslipidaemia and complications of DM [12].

Low serum magnesium levels may contribute to the development of diabetic complications such as retinopathy, abnormal platelet function, cardiovascular disease and hypertension via reduction of inositol transport rate and subsequent intracellular depletion. Hypomagnesaemia may occur following insulin therapy for diabetic ketoacidosis and may be related to the anabolic effects of insulin driving magnesium back into cells [10]. The reasons for high prevalence of Mg deficiency in diabetes are not clear, but may include increased urinary loss, lower dietary intake or impaired absorption of magnesium compared to healthy individuals. Increased urinary magnesium excretion due to hyperglycemia and osmotic diuresis may contribute to hypomagnesaemia in diabetes [13]. Therefore, the present study was aimed to determine the serum magnesium level and correlate it with HbA1c in DM patients.

Material and methods

Study population and place: This cross sectional study was conducted from July 2016 to June 2017 at the Department of Biochemistry, Dhaka Medical College, Dhaka. The study was approved by the Institutional Review Board. Informed written consents were obtained from all enrolled participants. By convenient and purposive sampling technique, a total of 100 individuals were enrolled according to the selection criteria. Out of 100 participants, 50 were diagnosed patients of DM (Group-A) attending the outpatient department of Endocrinology and Metabolism, Dhaka Medical College Hospital. Same number of age and sex matched apparently healthy individuals weas selected as control for comparison (Group-B). DM was defined as a condition of progressive pancreatic beta cell dysfunction having HbA1c level ≥ 6.5% or fasting plasma glucose (FPG) ≥ 7.0 mmol/l or two-hour plasma glucose ≥ 11.1 mmol/l during an oral glucose tolerance test (OGTT) or a random plasma glucose of ≥ 11.1 mmol/l in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis [14]. Known cases of type 1 diabetes mellitus, DM with acute complications, hypertension, malignancy, chronic liver disease, chronic kidney disease, acute illness, pregnant and lactating women, recent history of acute infection and diarrheal disease were excluded.All data were recorded in a predesigned data collection sheet.

Collection of blood samples and tests: Blood samples were collected from each individual in designated sterile tubes with aseptic precautions.Fasting plasma glucose was estimated enzymatically by glucose oxidase method. Plasma HbA1c was measured by high performance liquid chromatography. Values for HbA1c were: <5.7% normal, 5.7–6.4% pre-diabetes and ≥ 6.5% diabetes mellitus [15]. Quantitative serum magnesium was determined by colorimetric dye-complexing method using Evolution-3000 flow cell semi-auto- analyzer. Normal level of serum magnesium is 1.8-3.6 mg/dl [16].

Data analysis: Continuous variables were expressed as mean ± SD and were compared between groups of patients by unpaired Student’s t test. Categorical variables were compared using chi-square test. Pearson’s correlation coefficient was used to test the relationship between the parameters. The quantitative observations were indicated by absolute frequencies. The result was considered as statistically significant when p value was less than 0.05.

Results

The study was aimed to correlate serum Mg levels with HbA1c of DM patients. Table-1 shows the baseline parameters of the study population. There was no significant difference of age, sex, systolic blood pressure (BP), diastolic BP and body mass index (BMI) between Group-A and B cases. Out of 50 Group-A cases, 43 (86%) had serum magnesium below the normal reference range (< 1.8 mg/dl) while all the Group A cases were within the normal range.

Table-1: Baseline parameters of the Group-A and B study population (N = 100)

Table-2 shows the serum magnesium and HbA1c levels of the study subjects of both groups. Fasting plasma glucose and HbA1c levels were significantly (p < 0.001) higher in DM patients (Group-A) than healthy individuals (Group-B) while serum magnesium levels were significantly (p < 0.001) low in DM patients compared to healthy individuals.

Table-2: Serum magnesium and HbA1c levels of the study population (N = 100)

Pearson’s correlation coefficient test revealed that there was significant negative correlation between serum magnesium with HbA1c (r= -0.511, p<0.001; Figure-1).

Figure-1: Correlation of HbA1c with serum magnesium in Group A

Discussion

This cross sectional study investigated the level of serum magnesium in DM patients and in age and sex matched healthy individuals. We also evaluated the correlation of serum magnesium with HbA1c. Serum magnesium concentration was significantly lower in DM patients (p < 0.001) compared to healthy individuals.The finding of our study is in agreement with other reported studies [9,17] who also found significantly decreased level of serum magnesium in diabetic patients. The possible explanation of such hypomagnesaemia in DM cases could be due to higher urinary losses or impaired absorption of magnesium [9,10].

Correlation of serum magnesium with HbA1c was done. In the present study, we found negative correlation of serum magnesium levels with HbA1C (r = -0.511 and p < 0.001) in DM cases. Similar negative correlation of serum magnesium with HbA1c in diabetic cases has been reported by other studies [18]. The findings indicate that uncontrolled glycemia is associated with low serum magnesium status in DM cases. Therefore, it is concluded that regular assessment of serum magnesium would be helpful to prevent the complications related to hypomagnesaemia among DM patients.

Acknowledgement

The authors are grateful to the study participants for their participation and their kind cooperation throughout the study.

Conflict of interest

The authors declare no conflict of interest.

References

1.     World Health Organization. Global report on diabetes. Geneva: World Health Organization; 2016.

2.     Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004; 27(5): 1047-1053.

3.     Divers J, Mayer-Davis EJ, Lawrence JM, Isom S, Dabelea D, Dolan L, et al. Trends in incidence of type 1 and type 2 diabetes among youths - selected Counties and Indian Reservations, United States, 2002–2015. MMWR Morb Mortal Wkly Rep. 2020; 69(6): 161-165.

4.     Sanna A, Firinu D, Zavattari P, Valera P. Zinc status and autoimmunity: a systematic review and meta-analysis. Nutrients. 2018; 10(1): 68.

5.     Yanik M, Kocyigit A, Tutkun H, Vural H, Harken H. Plasma manganese, selenium, zinc, copper, and iron concentrations in patients with schizophrenia. Biol Trace Elem Res. 2004; 98: 109-117.

6.     Kirkland AE, Sarlo GL, Holton KF. The role of magnesium in neurological disorders. Nutrients. 2018; 10(6): 730.

7.     Ferdousi S, Mollah FH, Mia MAR. Serum levels of zinc and magnesium in newly diagnosed type 2 diabetic subjects. Bangladesh J Med Sci. 2010; 3(2): 46-49.

8.     Mahdizadeh R, Shirali S, Ebadi P. Investigation of imbalance of trace elements in patients with type 2 diabetes mellitus. J Acad Applied Studies. 2014; 4(9): 11-21.

9.     Pujar S, Pujar LL, Ganiger A, Hiremath K, Mannangi N, Bhuthal M. Correlation of serum zinc, magnesium and copper with HbA1c in type 2 diabetes mellitus patients among Bagalkot population - a case control study. Medica Innovatica. 2014; 3(2): 4-8.

10.  Puri M, Gujral U, Nayyar SB. Comparative study of serum zinc, magnesium and copper levels among patients of type 2 diabetes mellitus with and without microangiopathic complications. Innovative J Medical Health Science. 2013; 3: 274-278.

11.  Supriya, Mohanty S, Pinnelli VB, Murgod R, DS R. Evaluation of serum copper, magnesium and glycated haemoglobin in type 2 diabetes mellitus. Asian J Pharm Clin Res. 2013; 6(2): 188-190.

12.  Saha-Roy S, Bera S, Choudhury KM, Pal S, Bhattacharya A, Sen G, et al. Status of serum magnesium, zinc and copper in patients suffering from type 2 diabetes mellitus. J Drug Delivery Therapeutics. 2014; 4(1): 70-72.

13.  Monika KW, Michael BZ, Giatgen AS, Richard FH. Low plasma magnesium in type 2 diabetes. Swiss Med Wkly. 2003; 133: 289-292.

14.  American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010; 33(1): 62-69.

15.  American Diabetes Association. Standards of medical care in diabetes-2016. Diabetes Care. 2016; 39(1): 1-106.

16.  U.S. Food and Drug Administration. Investigations operations Manual 2017. Maryland: US Food and Drug Administration; 2017. 468 p.

17.  Farid SM, Abulfaraj TG. Trace mineral status related to levels of glycated hemoglobin of type 2 diabetic subjects in Jeddah, Saudi Arabia. Med J Islamic World Acad Sci. 2013; 21(2): 47-56.

18.  Jyothirmayi B, Vasantha M. Study of zinc and glycated Hb levels in diabetic complications. Int J Pharm Clin Res. 2015; 7(5): 360-363.

Cite this article as:

Ahmed F, Sultana N, Akter T. Correlation of serum magnesium with HbA1c in patients with diabetes mellitus. IMC J Med Sci. 2023. 17(1): 005.  DOI: https://doi.org/10.55010/imcjms.17.005