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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 3  |  Issue : 1  |  Page : 29-32

Hypomagnesemia as a cardiometabolic risk marker in type 2 diabetes mellitus: Implications for Sub-Saharan Africa


1 Department of Medicine, Endocrinology Unit, University College Hospital, Ibadan, Nigeria
2 Department of Chemical Pathology, University College Hospital, Ibadan, Nigeria

Date of Submission10-Mar-2021
Date of Decision09-Apr-2021
Date of Acceptance11-Apr-2021
Date of Web Publication28-May-2021

Correspondence Address:
Taoreed Adegoke Azeez
Department of Medicine, Endocrinology Unit, University College Hospital, Ibadan
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ACCJ.ACCJ_5_21

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  Abstract 


Background: Diabetes mellitus is a metabolic disorder associated with increased cardiovascular mortality. However, studies have suggested a possible link between hypomagnesemia and cardiovascular risk, but these studies are scanty in sub-Saharan Africa. This present study aimed to investigate the association between plasma magnesium and cardiovascular risk factors among type 2 diabetes patients. Methods: Seventy type 2 diabetes patients, with equal gender distribution, in a tertiary hospital in Nigeria were recruited. Ethical approval was obtained. Anthropometric measures were done as recommended. Plasma magnesium and fasting lipid profiles measured using standard protocols. Results: The mean age of the participants was 53.34 ± 9.57 years. The mean duration of diabetes mellitus among the participants was 6.29 ± 2.78 years. Central obesity and hypertension are the most prevalent cardiovascular risk factors among patients with type 2 diabetes. About 38.6% of the participants had suboptimal glycemic control. Nearly 64.3% had dyslipidemia. The frequency of hypomagnesemia among the participants was 25.7%. Hypomagnesemia was significantly associated with the presence of dyslipidemia (P = 0.042) and suboptimal glycemic control (P = 0.001). Conclusion: Hypomagnesemia is associated with cardiometabolic risk factors. Therefore, plasma magnesium could be used as a cheap marker of cardiovascular risk in low-resource settings like sub-Saharan Africa.

Keywords: Cardiometabolic risk, hypomagnesemia, plasma magnesium, sub-Saharan Africa, type 2 diabetes


How to cite this article:
Azeez TA, Sonuga OO. Hypomagnesemia as a cardiometabolic risk marker in type 2 diabetes mellitus: Implications for Sub-Saharan Africa. Ann Clin Cardiol 2021;3:29-32

How to cite this URL:
Azeez TA, Sonuga OO. Hypomagnesemia as a cardiometabolic risk marker in type 2 diabetes mellitus: Implications for Sub-Saharan Africa. Ann Clin Cardiol [serial online] 2021 [cited 2021 Nov 28];3:29-32. Available from: http://www.onlineacc.org/text.asp?2021/3/1/29/317104




  Introduction Top


Magnesium is the fourth most abundant cation in the body and most abundant divalent cation in the cells where it plays a critical role in cellular metabolism and homeostasis.[1] Hypomagnesemia is defined as serum or plasma magnesium level below the lower limit of reference interval which varies with the population and the methods used in assaying. At the cellular level, magnesium plays multiple roles in deoxyribonucleic acid stability, protein synthesis, and enzyme functions.[2] Deranged plasma magnesium levels are associated with diabetes mellitus and its complications.[3]

The incidence of hypomagnesemia in diabetes mellitus has been quoted as 13.5%–47.7%.[4] This wide range was believed to be due to differences in sociodemographics and assay methodologies.[4] There are multiple possible causes of hypomagnesemia in diabetes mellitus.[4] Gastrointestinal causes include reduced intake from dietary restriction, esophageal motility dysfunction from autonomic neuropathy, and diabetic gastroparesis causing recurrent nausea and vomiting as well as diarrhea.[4],[5] Renal losses may be due to hyperfiltration, osmotic diuresis, recurrent metabolic acidosis, and hypoalbuminemia.[4] Other proposed renal mechanisms of hypomagnesemia in type 2 diabetes are electrolyte disturbances such as hypokalemia and hypophosphatemia (which are relatively more common in diabetes), insulin resistance at the level of renal tubules, thereby enhancing magnesium wasting and the use of diuretics to control hypertension which often accompanies diabetes.[4],[6]

Hypomagnesemia affects both insulin secretion and action.[7] This assertion is supported by Guerrero-Romero et al., who demonstrated that magnesium supplementation improves insulin sensitivity in insulin-resistant participants.[8] Glucokinase activity in pancreatic beta cells requires magnesium and this is believed to be a major pathway by which hypomagnesemia impairs insulin secretion.[9] Similarly, magnesium is required for the various enzymes involved in the insulin signaling pathway and this is proposed to be the link between hypomagnesemia and insulin resistance.[10]

Previous studies have documented an association between hypomagnesemia and elevated glycated hemoglobin (HbA1c) in patients with diabetes.[2],[11],[12] Hypomagnesemia has also been associated with increased incidence of hypertension.[13] Furthermore, Shamnani et al. have reported hypomagnesemia as a predictor of obesity in a cross-sectional study conducted in India.[14] Similarly, other researchers have documented increased frequency of hypomagnesemia in patients with type 2 diabetes and dyslipidemia.[15] Furthermore, smoking has been previously documented to be associated with hypomagnesemia.[13]

In sub-Saharan Africa, the prevalence of diabetes mellitus and the associated cardiovascular risk factors are increasing but there is a paucity of information on the association between plasma magnesium and cardiometabolic risk factors in type 2 diabetes mellitus, hence the need for this study.[16]

Objectives

The objectives of the study were to determine the prevalence of hypomagnesemia in patients with type 2 diabetes and to evaluate the association between plasma magnesium and cardiometabolic risk factors such as hypertension, dyslipidemia, and obesity.


  Methods Top


The study was carried out among patients attending the diabetes clinic of a tertiary hospital in Nigeria. It was a cross-sectional study design. It involved 70 patients (35 males and 35 female) with type 2 diabetes mellitus. The joint University College Hospital and University of Ibadan Ethical Review Committee gave the ethical approval for the study. Furthermore, the recruited participants gave written consent to partake in the study.

Inclusion criteria

Individuals (30 years and above in age) who were previously diagnosed with type 2 diabetes, using the World Health Organization (WHO) criteria, were enrolled into the study.[17]

Exclusion criteria

Individuals diagnosed with any acute illness or hospitalized in the preceding 3 months to the study were excluded from the study. Other exclusion criteria were prior diagnosis with deranged magnesium levels, chronic diarrhea, usage of insulin or diuretics, magnesium-containing drugs, or supplements, and pregnancy.

Data collection

Trained assistants obtained the socioeconomic data with pretested structured questionnaires. Height was measured with a stadiometer while the weight was determined with a D-339 Detecto Eye-level Physician Beam Scale. Body mass index (BMI) was computed with the equation given below.[18] Waist circumference was measured following WHO recommendation.[19]

BMI = weight (kg)/height2 (m2)

Blood pressure was measured with a mercury sphygmomanometer following the recommendations of the European Society of Hypertension.[20] Using a fasting plasma sample, high-density lipoprotein-cholesterol (HDL-C), total cholesterol, and total glycerides were quantified using the enzymatic methods. Friedewald equation was employed in determining the low-density lipoprotein-cholesterol (LDL-C).[21] HbA1c was measured using the high-performance liquid chromatography method.

Participants had venous blood sample collected following an overnight fast of about 8–12 h. Fasting plasma glucose was determined by glucose oxidase enzymatic method on automated chemistry analyzer Landwind C100 plus. Total cholesterol, total triglyceride, and HDL-C were determined using the enzymatic method on automated chemistry analyzer Landwind C100 plus. LDL-C was calculated using the Friedewald equation provided that the triglyceride was not >400 mg/dl.[18]

LDL-C = Total cholesterol − HDL-C − total triglycerides/5.

Total cholesterol >200 mg/dl and/or total glyceride >150 mg/dl and/or HDL-C <40 mg/dl in males or <50 mg/dl in females is considered as dyslipidemia. HbA1c was determined using ion-exchange high-performance liquid chromatography method. Plasma magnesium was determined using Xylidyl Blue Monoreagent method on automated chemistry analyzer Landwind C100 plus.

Data analysis

The collected data were critically examined and were carefully entered into Microsoft Excel datasheet. The data were later analyzed the Statistical Package for the Social Sciences software, (SPSS) version 22 (IBM (International Business Machines Corporation), New York, USA). Quantitative variables were presented as mean ± standard deviation whereas categorical variables were presented as frequencies and percentages. The association between categorical variables was determined with the Chi-square test. P < 0.05 was considered to be statistically significant.

Definition of terms

Dyslipidemia – Fasting total cholesterol >200 mg/dl and/or fasting triglyceride >150 mg/dl and/or LDL-C >130 mg/dl and/or HDL-C <40 mg/dl (in males) or 50 mg/dl (in females).[22]

Hypertension – Systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg or being on antihypertensives.[23]

Obesity – BMI ≥ 30 kg/m2.[24]

Overweight – BMI 25–29.9 kg/m2.[24]

Central obesity – Waist circumference ≥94 cm in males or 80 cm in females.[25]

Hypomagnesemia – Plasma magnesium <1.7 mg/dl.

Suboptimal glycemic control – HbA1c above 7%.


  Results Top


Seventy participants were involved in the study. There were 35 males and 35 females. The mean age of the participants was 53.34 ± 9.57 years. [Table 1] depicts the socioeconomic features of the participants. The mean duration of diabetes mellitus among the participants was 6.29 ± 2.78 years.
Table 1: Socioeconomic data of the participants

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[Figure 1] shows the prevalence of cardiometabolic risk factors among the participants. Central obesity and hypertension are the most prevalent cardiovascular risk factors among patients with type 2 diabetes. Nearly 38.6% of the participants had suboptimal glycemic control.
Figure 1: Prevalence of cardiometabolic risk factors among the participants

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The frequency of hypomagnesemia among the participants was 25.7%. [Table 2] shows the association between hypomagnesemia and cardiometabolic risk factors. Hypomagnesemia was significantly associated with the presence of dyslipidemia (P = 0.042) and suboptimal glycemic control (P = 0.001).
Table 2: Association between hypomagnesemia and various cardiometabolic risk factors

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  Discussion Top


The frequency of hypomagnesemia among patients with type 2 diabetes mellitus, in this study, was 25.7%. This is comparable to the findings of another study done among Nigerian patients with type 2 diabetes where a frequency of hypomagnesemia of 23.2% was reported.[26] The various etiological links between hypomagnesemia and type 2 diabetes mellitus are dietary restrictions, autonomic gastrointestinal disorders, renal losses, and medications such as metformin.[10]

There was a significant association between hypomagnesemia and dyslipidemia among patients with type 2 diabetes mellitus. Previous studies have also documented an association between hypomagnesemia and dyslipidemia among patients with type 2 diabetes mellitus.[12],[15],[27] It has been documented that hypomagnesemia inhibits lipoprotein lipase and lecithin–cholesterol acyltransferase and enhances the effects of 3-hydroxy-3-methylglutaryl coenzyme A transferase, and these mechanisms have been hypothesized as the explanation for the association between hypomagnesemia and dyslipidemia.[27]

Similarly, this study demonstrated a significant association between hypomagnesemia and suboptimal glycemic control. The findings of other previous studies are in keeping with this result.[2],[7],[28] Osmotic diuresis from persistent hyperglycemia and gastrointestinal losses from gastroparesis and diarrhea are some of the documented explanations for this observation.[3],[4],[14]

Magnesium is relatively cheap and simple to assay but it is often unchecked in patients with type 2 diabetes.[1],[9] In low-resource settings, like sub-Saharan Africa, the implications of this are that plasma magnesium should be routinely checked and those who have hypomagnesemia should have a further screening of their metabolic profiles. In other words, in resource-poor settings, as is obtainable in sub-Saharan Africa, hypomagnesemia could be used as a cheap and simple surrogate marker of poor metabolic control in patients with type 2 diabetes. Furthermore, since studies have shown a significant association between poor metabolic control and cardiovascular death, it can be concluded that plasma magnesium could be a reliable cardiovascular risk indicator in low-resource settings such as sub-Saharan Africa.[29],[30]


  Conclusion Top


Hypomagnesemia is a common in patients with type 2 diabetes and it is significantly associated with HbA1c and fasting lipid profile. It may be used as a marker of cardiometabolic risk in sub-Saharan Africa.

Limitations

The sample size was small and it was a hospital-based study so the generalizability to the community may require some caution.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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    Figures

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    Tables

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