Volume: 3: Issue-6: December-2014

Research Article ISSN:2278-0246

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SERUM MAGNESIUM IN TYPE 2 DIABETES MELLITUS: CASE CONTROL STUDY IN RURAL TEACHING HOSPITAL Prasad Gurjar1, Sunil Kumar2, SK Diwan3, M.M.Patil4 1

Senior resident, Department of Medicine, JNMC, DMIMSU, Wardha, Maharashtra, India. Professor, Department of Medicine, JNMC, DMIMSU, Wardha, Maharashtra, India. Corresponding address: Sunil kumar, Professor Department of Medicine, JNMC, Wardha, Maharashtra, India. Conflict of interest –nil, Abstract Words -239, Article Words – 2989. Telephone/Moble: 9850393787 Fax: E-mail: [email protected] 3 Professor, Department of Medicine, JNMC, DMIMSU, Wardha, Maharashtra, India. 4 Professor, Department of Medicine, JNMC, DMIMSU, Wardha, Maharashtra, India 2

ABSTRACT: Introduction Diabetes mellitus is most common metabolic disorder in the world and leading cause of death and disability in the world. Magnesium depletion has a negative impact on glucose homeostasis and insulin sensitivity in patients with Type 2 diabetes. In this study we have planned correlation of serum magnesium with diabetes mellitus. Material and method: We enrolled100 cases of type 2 diabetic patients, and 100 age / sex matched non diabetic controls of age group 35 to 80 years. All patients and controls underwent thorough clinical examination and required laboratory investigation.Statistical analysis was done by using descriptive and inferential statistics using Chi-square Test, Z-test for difference between two means and Pearson’s Correlation Coefficient. Result and Conclusion: 33 % of diabetic patients had low serum magnesium levels and 5% of non diabetic controls had low serum magnesium levels. The mean serum magnesium level was 1.69±0.31 mg/dL and 2.04±0.28 mg/dL in diabetics and controls respectively (0.000 S, p < 0.05).Serum magnesium level were inversely proportional to BMI and W: H ratio. Mean FBS level was 190.29±70.95 mg/dL in cases and 95.12±43 mg/dL in controls. The serum magnesium levels were inversely proportional to FBS in cases and control. (0.000 S, p < 0.05)Mean HbA1C level was 8.83 ±1.88 %.The serum magnesium levels were inversely proportional to HbA1c in cases (0.000 S, p < 0.05). Significant association between serum magnesium level and retinopathy, neuropathy, nephropathy. P value was significant. Keywords: Serum Magnesium, Diabetes Mellitus, Prevalence, Case Control, India.

INTRODUCTION Diabetes mellitus is one of the most common metabolic disorder and leading cause of death and disability in the world. The incidence of diabetes is increasing globally and in India. According to International Diabetes Federation, 381.8 million people in the world lived with diabetes in 2013 and it would be 591.9 million in 2035, total increase is of 55%. 175 million people with diabetes were undiagnosed worldwide. The greatest numbers of people with diabetes are between 40- 59 years of age. Diabetes caused 5.1 million deaths in 2013, every six seconds a person dies from diabetes. Diabetes cause at least Expenditure of 548 billion dollar in year 2013, 11% of total health expenditure in adult worldwide. China has largest number of people with diabetes (98.4 million), followed by India (65.1 million).1 In India the prevalence rate of diabetes has been increased dramatically since the first national survey undertaken, in 1971. At that time prevalence was 2.3% in urban area and 1.2% in rural area. The recent study suggest prevalence rate between15-20% in urban area and about half of that in rural area. Most of people have type 2 diabetes mellitus. Type 1 diabetes contributes around 5% of total number of diabetes patients.The reason

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for explosive increase in the prevalence of diabetes in India is genetic makeup of the of the Indian population, urbanization and altered life¬styles and aging of population.2 Hypomagnesemia is a common feature in patients with type 2 diabetes. Although diabetes can induce hypomagnesemia, magnesium deficiency has also been proposed as a risk factor for type 2 diabetes mellitus. Magnesium is a necessary cofactor for several enzymes that play an important role in glucose metabolism. Some short-term metabolic studies suggest that magnesium supplementation has a beneficial effect on insulin action and glucose metabolism.3

MATERIAL AND METHODS Study Design:- Study type: The study was comparative prospective study and had been approved by the Institutional Ethics Committee. The study had been carried out over a period from September 2012- September 2014 in Medicine Department of rural teaching Hospital in rural central India. - Sample Size:In these study 100 patients of type 2 diabetes mellitus (cases) along with 100 non diabetes patients (control) admitted in medicine department. Informed and written consent was taken from cases and controls. - Inclusion criteria: o Cases - Diagnosed cases of type 2 DM willing to participate in study (either sex) o Control group (inclusion criteria) - Age (difference of ±5 years) and sex matched non diabetic patient admitted in the hospital. - Exclusion criteria o Gastrointestinal disorder (chronic diarrhea, gastrointestinal fistula, mal absorption) o Impaired renal function (chronic renal disease) o Alcoholic pancreatitis o Diuretic therapy (Thiazide) o Drug ( magnesium containing antacids).

SAMPLE COLLECTION Method: A venous blood sample 5cc was collected in disposable syringe for estimation of serum total magnesium levels, blood glucose level (post prandial and fasting) and HbA1c and sent to laboratory for analysis. Calmagite method was used for measurement of serum magnesium level. The normal value of serum total magnesium was between 1.5 to 2.5 mg/dl. Method of Collection of Data: History and clinical findings were noted for each patient. Other hematological, biochemical and radiological investigations were also performed as indicated in every patient who was fit for these study criteria were studied. Pulse, blood pressure, temperature, height, weight, body mass index, waist hip ratio and detailed systemic examination were carried out in all patients and controls. Fundoscopic examination was done in all cases.

DEFINITION In our laboratory, normal magnesium concentration values were 1.5 to 2.5 mg/dl. Hypomagnesemia was defined as a serum magnesium level of 1.49 mg/dl or less; Hypermagnesemia was defined as 2.51 mg/dl or more. Method of Estimation of Serum Magnesium by Calmigite Method Principle of the test: It is an enzymatic end point method. Principle of reaction is that, the Calmagite combines with the magnesium in alkaline medium to form a red complex which is measured at 520 run. Intensity of the colour formed is directly proportional to the amount of magnesium present in the sample.

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Reagent is in liquid form ready for use. A magnesium standard is provided with the reagent. Wave length : 520 nm. Temperature : 370 c Cuvette : 10 nm path length Incubation : 5 minutes Standard : 2 mEq/L Kit used in this study was RAICHEM's Magnesium liquid reagent.

STATISTICAL ANALYSIS Statistical analysis was done by using descriptive and inferential statistics using Chi-square Test, Z-test for difference between two means and Pearson’s Correlation Coefficient. The software used in the analysis was SPSS17.0 and Graph Pad Prism 5.0 and p0.80) it was 1.66±0.29 mg /dL. (Table 3 and 4) The mean serum magnesium level was 1.69±0.31 mg/dL and 2.04±0.28 mg/dL in diabetics and controls respectively (0.000 S, p < 0.05).Type 2 diabetic patients had higher incidence of lower serum magnesium levels when compared to age and sex matched controls.(Table 5) In our study mean FBS level was 190.29±70.95 mg/dL in cases and 95.12±43 mg/dL in controls. The serum magnesium levels were inversely proportional to FBS level in cases and control. (0.000 S, p < 0.05) (Table 6) In our study mean HbA1C level was 8.83 ±1.88 % and there was inverse correlation between HbA1c level and serum magnesium level.Mean serum magnesium level in cases with HbA1C level > 9% was 1.44±0.18 mg/dL. (0.000 S, p