Hypomagnesaemia and its determinants in a contemporary primary care cohort of persons with type 2 diabetes

Femke Waanders, Robin P F Dullaart, Michel J Vos, Steven H Hendriks, Harry van Goor, Henk J G Bilo, Peter R van Dijk, Femke Waanders, Robin P F Dullaart, Michel J Vos, Steven H Hendriks, Harry van Goor, Henk J G Bilo, Peter R van Dijk

Abstract

Aims: Among persons with type 2 diabetes mellitus (T2DM) hypomagnesaemia has been reported in 14-48% of patients. This may be of significance given the emerging associations of hypomagnesaemia with glucometabolic disturbances and possibly even complications. We assessed the prevalence of hypomagnesaemia and its determinants, in a well-defined cohort of persons with T2DM treated in primary care.

Methods: Observational cohort study among persons with T2DM treated in primary care in the Northeast of the Netherlands. Magnesium was measured using a colorimetric endpoint assay (Roche). Hypomagnesaemia was defined as a serum magnesium level <0.70 mmol/L. Pearson correlations were performed to correlate variables with serum magnesium. Next, a stepwise backward regression model was made.

Results: Data of 929 persons (55% male) with a mean age of 65 (± 10) years, diabetes duration 6.5 [3.0-10.1] years, and HbA1c concentration 6.7 (± 0.7)% (50 (± 9) mmol/mol) were analysed. Serum magnesium was 0.79 (± 0.08) mmol/L. The percentage of persons with magnesium deficiency was 9.6%. Age, diabetes duration, BMI, HbA1c, use of metformin, sulfonylurea derivatives, and DPP4 inhibitors were negatively associated with magnesium concentrations. In contrast, LDL cholesterol and serum creatinine were positively associated serum magnesium.

Conclusions: Hypomagnesaemia was present in 9.6% of T2DM patients treated in primary care. This percentage is remarkably lower than reported previously, possibly due to the unselected nature of our population. Concerning T2DM-related factors, only BMI, HbA1c and the use of metformin, sulfonylurea derivatives and DPP4 inhibitors correlated negatively with magnesium concentrations.

Trial registration: ClinicalTrials.gov NCT01570140.

Keywords: Hypomagnesaemia; Magnesium; Prevalence; Type 2 diabetes.

Conflict of interest statement

The authors declare that they have no conflict of interest.

References

    1. Gommers LMM, Hoenderop JGJ, Bindels RJM, de Baaij JHF. Hypomagnesemia in type 2 diabetes: a vicious circle? Diabetes. 2016;65:3–13. doi: 10.2337/db15-1028.
    1. Pham P-CT, Pham P-MT, Pham SV, et al. Hypomagnesemia in patients with type 2 diabetes. Clin. J. Am. Soc. Nephrol. 2007;2:366–373. doi: 10.2215/CJN.02960906.
    1. J.C. Schutten, A.W. Gomes-Neto., G. Navis, et al. Lower plasma magnesium, measured by nuclear magnetic resonance spectroscopy, is associated with increased risk of developing type 2 diabetes mellitus in women: results from a Dutch prospective cohort study. J. Clin. Med. 8, 1–16 (2019). 10.3390/jcm8020169
    1. Simental-Mendía LE, Sahebkar A, Rodríguez-Morán M, Guerrero-Romero F. A systematic review and meta-analysis of randomized controlled trials on the effects of magnesium supplementation on insulin sensitivity and glucose control. Pharmacol. Res. 2016;111:272–282. doi: 10.1016/j.phrs.2016.06.019.
    1. Nadler JL, Buchanan T, Natarajan R, et al. Magnesium deficiency produces insulin resistance and increased thromboxane synthesis. Hypertens. Dallas Tex. 1979. 1993;21:1024–1029.
    1. Paolisso G, Sgambato S, Gambardella A, et al. Daily magnesium supplements improve glucose handling in elderly subjects. Am. J. Clin. Nutr. 1992;55:1161–1167. doi: 10.1093/ajcn/55.6.1161.
    1. Hruby A, Meigs JB, O’Donnell CJ, et al. Higher magnesium intake reduces risk of impaired glucose and insulin metabolism and progression from prediabetes to diabetes in middle-aged americans. Diabetes Care. 2014;37:419–427. doi: 10.2337/dc13-1397.
    1. Ma J, Folsom AR, Melnick SL, et al. Associations of serum and dietary magnesium with cardiovascular disease, hypertension, diabetes, insulin, and carotid arterial wall thickness: the ARIC study. Atherosclerosis Risk in Communities Study. J. Clin. Epidemiol. 1995;48:927–940. doi: 10.1016/0895-4356(94)00200-A.
    1. de Lordes Lima M, Cruz T, Pousada JC, et al. The effect of magnesium supplementation in increasing doses on the control of type 2 diabetes. Diabetes Care. 1998;21:682–686. doi: 10.2337/diacare.21.5.682.
    1. McNair P, Christensen MS, Christiansen C, et al. Renal hypomagnesaemia in human diabetes mellitus: its relation to glucose homeostasis. Eur. J. Clin. Investig. 1982;12:81–85. doi: 10.1111/j.1365-2362.1982.tb00942.x.
    1. M.K. Wälti, M.B. Zimmermann, G.A. Spinas, R.F. Hurrell, Low plasma magnesium in type 2 diabetes. Swiss Med. Wkly 133, 289–292 (2003). 10.2003/19/smw-10170.
    1. Mikhail N, Ehsanipoor K. Ionized serum magnesium in type 2 diabetes mellitus: its correlation with total serum magnesium and hemoglobin A1c levels. South Med. J. 1999;92:1162–1166. doi: 10.1097/00007611-199912000-00005.
    1. Kurstjens S, de Baaij JHF, Bouras H, et al. Determinants of hypomagnesemia in patients with type 2 diabetes mellitus. Eur. J. Endocrinol. 2017;176:11–19. doi: 10.1530/EJE-16-0517.
    1. Roelofsen Y, Hendriks SH, Sieverink F, et al. Design of the e-Vita diabetes mellitus study: effects and use of an interactive online care platform in patients with type 2 diabetes (e-VitaDM-1/ZODIAC-40) BMC Endocr. Disord. 2014;14:22. doi: 10.1186/1472-6823-14-22.
    1. Hendriks SH, van Soldt EGW, van Vugt M, et al. Lifestyle and emotional well-being in men and women with type 2 diabetes (e-VitaDM-4; ZODIAC-48) Eur. J. Gen. Pract. 2017;23:83–90. doi: 10.1080/13814788.2017.1292348.
    1. International Diabetes Federation Guideline Development Group Global guideline for type 2 diabetes. Diabetes Res. Clin. Pract. 2014;104:1–52. doi: 10.1016/j.diabres.2012.10.001.
    1. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin. Chem. 1972;18:499–502.
    1. P.R. van Dijk, J.C. Schutten, E.J. Jeyarajah, et al. Blood Mg2+ is more closely associated with hyperglycaemia than with hypertriacylglycerolaemia: the PREVEND study. Diabetologia (2019). 10.1007/s00125-019-4929-7
    1. Mather HM, Nisbet JA, Burton GH, et al. Hypomagnesaemia in diabetes. Clin. Chim. Acta Int. J. Clin. Chem. 1979;95:235–242. doi: 10.1016/0009-8981(79)90364-4.
    1. Saeed H, Haj S, Qasim B. Estimation of magnesium level in type 2 diabetes mellitus and its correlation with HbA1c level. Endocrinol. Diabetes Metab. 2019;2:e00048. doi: 10.1002/edm2.48.
    1. Barbagallo M, Dominguez LJ. Magnesium and type 2 diabetes. World J. Diabetes. 2015;6:1152–1157. doi: 10.4239/wjd.v6.i10.1152.
    1. Ter Braake AD, Shanahan CM, de Baaij JHF. Magnesium counteracts vascular calcification: passive interference or active modulation? Arterioscler Thromb. Vasc. Biol. 2017;37:1431–1445. doi: 10.1161/ATVBAHA.117.309182.
    1. Schnack C, Bauer I, Pregant P, et al. Hypomagnesaemia in type 2 (non-insulin-dependent) diabetes mellitus is not corrected by improvement of long-term metabolic control. Diabetologia. 1992;35:77–79. doi: 10.1007/BF00400855.
    1. Ly JP, Onay T, Sison K, et al. The Sweet Pee model for Sglt2 mutation. J. Am. Soc. Nephrol. 2011;22:113–123. doi: 10.1681/ASN.2010080888.

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