Hypomagnesemia and Poor Glycemic Control among Type 2 Diabetic Patients: A Cross-Sectional Study

Hypomagnesemia in adults with type 2 diabetes mellitus in Riyadh, Saudi Arabia: A cross-sectional study

This study investigates the prevalence of hypomagnesemia in adults with type 2 diabetes mellitus (T2DM) in Riyadh, Saudi Arabia, and examines its association with various metabolic parameters. Conducted as a cross-sectional study at King Saud University, Riyadh, it included 294 Saudi adults aged 25 to 65 years, comprising 119 T2DM patients, 80 prediabetics, and 95 nondiabetic controls. Participants underwent physical examinations, and fasting blood samples were analyzed for glucose, glycated hemoglobin (HbA1c), lipid profile, and serum magnesium levels. Statistical analysis revealed that lower magnesium levels were significantly more prevalent in T2DM patients (1.65 ± 4.9 mg/L) compared to prediabetes (2.48 ± 5.2 mg/L) and controls (2.9 ± 5.4 mg/L; P < .001). T2DM patients with magnesium deficiency exhibited higher levels of fasting glucose (11.2 ± 3.9 mmol/L), HbA1c (8.6 ± 2.1 mmol/L), and triglycerides (2.1 ± 0.9 mmol/L), along with increased insulin resistance (Homeostatic Model Assessment of Insulin Resistance = 6.6) and decreased insulin sensitivity (Quantitative Insulin Sensitivity Check Index = 0.29). Magnesium levels correlated negatively with glucose (R = -0.58) and HbA1c (R = -0.61). The area under the curve for serum magnesium in predicting HbA1c > 5.7 was 0.88, and for HbA1c ≥ 6.5, it was 0.91, indicating high diagnostic accuracy. These findings suggest that magnesium deficiency significantly impacts the metabolic profile of T2DM patients in Riyadh. Therefore, routine monitoring of magnesium levels is crucial in diabetes management, and further research is needed to explore the benefits of magnesium supplementation in T2DM care.

Global prevalence of hypomagnesemia in type 2 diabetes mellitus - a comprehensive systematic review and meta-analysis of observational studies

PURPOSE

Hypomagnesemia, characterized by low magnesium levels, has been implicated in the pathophysiology of Type 2 Diabetes Mellitus (T2DM). This meta-analysis aims to provide a comprehensive assessment of hypomagnesemia prevalence in individuals with T2DM as well as its potential implications for diabetes management and complications.

METHODS

We conducted a comprehensive systematic review and meta-analysis using databases like PubMed, Google Scholar, Science Direct, and Research Gate to identify relevant studies between January 2008 and August 2023. We focused on observational studies related to serum magnesium levels and Type 2 Diabetes in individuals aged 19 and older. Newcastle Ottawa tool was used for quality assessment. A random effect meta-analysis was performed to calculate the prevalence of hypomagnesemia in T2DM.

RESULTS

We identified a total of 671 studies, and after screening 383 abstracts and full texts by two independent reviewers, we identified 19 eligible studies encompassing 4192 patients diagnosed with T2DM. The mean age was 55.4 (SD, 4.39) years with a mean HbA1C level of 8.01. The pooled prevalence of hypomagnesemia in T2DM was 32% (95% CI: 22-36%) out of 4192 cases. On subgroup analysis, the prevalence of hypomagnesemia in male and female were 19.8% and 20.1%, respectively. Geographically, Asia had the highest prevalence of hypomagnesemia with 31.9% (95% CI: 24-41.1%).

CONCLUSION

This meta-analysis highlights a significant prevalence of hypomagnesemia in individuals with T2DM, emphasizing the need for further investigation due to the intricate nature of the association between serum magnesium levels and T2DM.

How the kidney regulates magnesium: a modelling study

The kidneys are crucial for maintaining Mg2+ homeostasis. Along the proximal tubule and thick ascending limb, Mg2+ is reabsorbed paracellularly, while along the distal convoluted tubule (DCT), Mg2+ is reabsorbed transcellularly via transient receptor potential melastatin 6 (TRPM6). TRPM6 and other renal transporter expressions are regulated by sex hormones. To investigate renal Mg2 handling, we have developed sex-specific computational models of electrolyte transport along rat superficial nephron. Model simulations indicated that along the proximal tubule and thick ascending limb, Mg2+ and Na+ transport occur parallelly, but they are dissociated along the DCT. In addition, our models predicted higher paracellular Mg2+ permeability in females to attain similar cortical thick ascending limb fractional Mg2+ reabsorption in both sexes. Furthermore, DCT fractional Mg2+ reabsorption is higher in females than in males, allowing females to better fine-tune Mg2+ excretion. We validated our models by simulating the administration of three classes of diuretics. The model predicted significantly increased, marginally increased and significantly decreased Mg2+ excretions for loop, thiazide and K-sparing diuretics, respectively, aligning with experimental findings. The models can be used to conduct in silico studies on kidney adaptations to Mg2+ homeostasis alterations during conditions such as pregnancy, diabetes and chronic kidney disease.