Düşük Magnezyum Seviyeleri Tip 2 Diyabetli Hastalarda Polinöropati Gelişimi İçin Bir Risk Faktörü Olarak Ortaya Çıkabilir
Year 2021,
Volume: 13 Issue: 2, 169 - 174, 07.06.2021
Mehmet Mühürdaroğlu
,
Ezgi Ağadayı
,
Arzu Kösem
Abstract
Amaç: Magnezyum metabolizmasındaki değişiklik, diyabetin gelişimi ve ilerlemesi üzerine metabolik ve sinyal yollarında farklı bir etkiye sahiptir. Bu çalışmanın amacı tip 2 Diabetes Mellitusu (DM) olan hastalarda serum magnezyum düzeyinin polinöropati üzerine ilişkisini belirlemektir.
Metod: Bu çalışmaya Ankara Şehir Hastanesi nöroloji polikliniğine el ve ayaklarda ağrı ve yanma şikayeti ile başvurup polinöropati ön tanısıyla elektronöromiyografisi (ENMG) yapılan Tip 2 DM tanılı hastalar dahil edildi. Hastaların biyokimya ve hormon parametreleri retrospektif olarak tarandı.
Bulgular: Çalışmaya 49 (%42,2)’u kadın, 67 (%57,8)’i erkek toplam 116 hasta dahil edildi. Hastaları HbA1C düzeylerini tertile göre 3 gruba ayırdığımızda, HbA1C değeri yüksek grupta nöropati görülme sıklığı anlamlı olarak daha fazlaydı (P=0,004). Magnezyum seviyesi ile ENMG’de polinöropati saptanma arasında anlamlı ilişki tespit edildi (P=0,013). Polinöropati dışında ek komplikasyonu olan hastaların magnezyum seviyeleri olmayanlara göre anlamlı derecede daha düşüktü (P=0,021).
Sonuç: Bu çalışmada Tip 2 DM tanılı hastalarında polinöropati gelişimiyle magnezyum düzeylerinin anlamlı derecede ilişkili olduğunu göstermiştir. Glisemik kontrolü sağlanan hastalarda yeteli magnezyum seviyesinin diyabetik polinöropati gelişimini önleyebileceği sonucuna ulaşılmıştır.
Supporting Institution
yok
References
- 1. Davies M, Brophy S, Williams R, Taylor A. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care. 2006;29(7):1518.
- 2. Ziegler D, Rathmann W, Dickhaus T, Meisinger C, Mielck A, KORA Study Group. Neuropathic pain in diabetes, prediabetes and normal glucose tolerance: the MONICA/KORA Augsburg Surveys S2 and S3. Pain Med. 2009;10(2):393.
- 3. Young RJ, Ewing DJ, Clarke BF. Chronic and remitting painful diabetic polyneuropathy. Correlations with clinical features and subsequent changes in neurophysiology. Diabetes Care. 1988;11(1):34-40.
- 4. Siddiqui K, Bawazeer N, Joy SS. Variation in macro and trace elements in progression of type 2 diabetes. Scientific World Journal. 2014;461591.
- 5. Gommers LM, Hoenderop JG, Bindels RJ, de Baaij JH. Hypomagnesemia in type 2 diabetes: A vicious circle? Diabetes. 2016;65(1):3–13.
- 6. Pham PC, Pham PM, Pham SV, Miller JM, Pham PT. Hypomagnesemia in patients with type 2 diabetes. Clin J Am Soc Nephrol. 2007;2(2):366–373.
- 7. Pokharel DR, Khadka D, Sigdel M, Yadav NK, Kafle R, Sapkota RM, et al. Association of serum magnesium level with poor glycemic control and renal functions in Nepalese patients with type 2 diabetes mellitus. Diabetes Metab Syndr. 2017;Suppl 1:417–423.
- 8. Agrawal P, Arora S, Singh B, Manamalli A, Dolia PB. Association of macrovascular complications of type 2 diabetes mellitus with serum magnesium levels. Diabetes Metab Syndr. 2011;5(1):41–44.
- 9. Wayner DD, Burton GW, Ingold KU, Locke S. Quantitative measurement of the total, peroxyl radical-trapping antioxidant capability of human blood plasma by controlled peroxidation. The important contribution made by plasma proteins. FEBS Lett. 1985;187(1):33–37.
- 10. Halliwell B. Albumin—an important extracellular antioxidant? Biochem Pharmacol. 1988;37(4):569–571.
- 11. Roche M, Rondeau P, Singh NR, Tarnus E, Bourdon E. The antioxidant properties of serum albumin. FEBS Lett. 2008;582(13):1783–1787.
- 12. Peng F, Yang Y, Liu J, Jiang Y, Zhu C, Deng X, et al. Low antioxidant status of serum uric acid, bilirubin and albumin in patients with neuromyelitisoptica. Eur J Neurol. 2012;19(2):277–283.
- 13. Ghafourifar P, Mousavizadeh K, Parihar MS, Nazarewicz RR, Parihar A, Zenebe WJ. Mitochondria in multiple sclerosis. Front Biosci. 2008;13:3116–3126.
- 14. Fuhua P, Xuhui D, Zhiyang Z, Ying J, Yu Y, Feng T, et al. Antioxidant status of bilirubin and uric acid in patients with myasthenia gravis. Neuroimmunomodulation. 2012;19(1):43–49.
- 15. Su Z, Chen Z, Xiang Y, Wang B, Huang Y, Yang D, et al. Low serum levels of uric acid and albumin in patients with Guillain–Barre syndrome. Medicine. 2017;96(15):e6618.
- 16. Smilde TDJ, Van Veldhuisen DJ, Navis G, Voors AA, Hillege HL. Drawbacks and prognostic value of formulas estimating renal function in patients with chronic heart failure and systolic dysfunction. Circulation. 2006;114(15):1572–1580.
- 17. Genuth S. Insights from the diabetes control and complications trial/epidemiology of diabetes interventions and complications study on the use of intensive glycemic treatment to reduce the risk of complications of type 1 diabetes. Endocr Pract. 2006;Suppl 1:34-41.
- 18. Janghorbani M, Rezvanian H, Kachooei A, Ghorbani A, Chitsaz A, Izadi F, et al. Peripheral neuropathy in type 2 diabetes mellitus in Isfahan, Iran: prevalence and risk factors. Acta Neurol Scand. 2006;114(6):384-391.
- 19. Palmer BF, Clegg DJ. Electrolyte and acid-base disturbances in patients with diabetes mellitus. N Engl J Med. 2015;373(6):548-559.
- 20. Song Y, Manson JE, Buring JE, Liu S. Dietary magnesium intake in relation to plasma insulin levels and risk of type 2 diabetes in women. Diabetes Care. 2004;27(1):59-65.
- 21. Chung T, Prasad K, Lloyd TE. Peripheral neuropathy: clinical and electrophysiological considerations. Neuroimaging Clin N Am. 2014; 24(1):49-65.
- 22. Zhang Qi, Ji L, Zheng H, Li Q, Xiong Q, Sun W, et al. Low serum phosphate and magnesium levels are associated with peripheral neuropathy in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract. 2018;146:1–7.
- 23. Chu C, Zhao W, Zhang Y, Li L, Lu J, Jiang L, et al. Low serum magnesium levels are associated with impaired peripheral nerve function in type 2 diabetic patients. Sci Rep. 2016;6:32623.
- 24. Crescenzso R, Bianco F, Mazzoli A, Giacco A, Liverini G, Iossa S. Mitochondrial efficiency and insulin resistance. Front Physiol. 2014;5:512.
- 25. Rodriguez-Moran M, Guerrero-Romero F. Oral magnesium supplementation improves insulin sensitivity and metabolic control in type 2 diabetic subjects: a randomized double-blind controlled trial. Diabetes Care. 2003;26(4):1147-1152.
- 26. Razzaghi R, Pidar F, Momen-Heravi M, Bahmani F, Akbari H, Asemi Z. Magnesium supplementation and the effects on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. Biol Trace Elem Res. 2018;181(2): 207-215.
- 27. Arfuzir NN, Lambuk L, Jafri AJ, Agarwal R, Iezhitsa I, Sidek S, et al. Protective effect of magnesium acetyltaurate against endothelin-induced retinal and optic nerve injury. Neuroscience. 2016;325:153-164.
28. Corsonello A, Ientile R, Buemi M, Cucinotta D, Mauro VN, Macaione S, et al. Serum ionized magnesium levels in type 2 diabetic patients with microalbuminuria or clinical proteinuria. Am J Nephrol. 2000;20(3):187-192.
- 29. Wang S, Hou X, Liu Y, Lu H, Wei L, Bao Y, et al. Serum electrolyte levels in relation to macrovascular complications in Chinese patients with diabetes mellitus. Cardiovasc Diabetol. 2013;12:146.
- 30. Hamdan HZ, Nasser NM, Adam AM, Saleem MA, Elamin MI. Serum magnesium, iron and ferritin levels in patients with diabetic retinopathy attending Makkah Eye Complex, Khartoum, Sudan. Biol Trace Elem Res. 2015;165(1):30-34.
- 31. Sharma A, Dabla S, Agrawal RP, Barjatya H, Kochar DK, Kothari RP. Serum magnesium: An early predictor of course and complications of diabetes mellitus. J Indian Med Assoc. 2007;105(1):16-20.
- 32. Suhail M. Na, K-ATPase: Ubiquitous multifunctional transmembrane protein and its relevance to various pathophysiological conditions. J Clin Med Res. 2010;2(1):1–17.
- 33. Grafton G, Baxter MA. The role of magnesium in diabetes mellitus. A possible mechanism for the development of diabetic complications. J Diabetes Complications. 1992;6(2):143–149.
- 34. Iwasaki T, Togashi Y, Terauchi Y. Significant association of serum albumin with severity of retinopathy and neuropathy, in addition to that of nephropathy, in Japanese type 2 diabetic patients. Endocr J. 2008;55(2):311-316.
Can Low Magnesium be A Rısk Factor for the Development of Polyneuropathy in Patıents With Diabetes?
Year 2021,
Volume: 13 Issue: 2, 169 - 174, 07.06.2021
Mehmet Mühürdaroğlu
,
Ezgi Ağadayı
,
Arzu Kösem
Abstract
Objective: Changes in magnesium metabolism have a different effect on the metabolic and signaling pathways in the development and progression of diabetes. This study aimed to determine the relationship between the serum magnesium level and polyneuropathy in patients with type 2 diabetes mellitus (DM).
Method: The study included type 2 DM patients who presented to the neurology outpatient clinic of Ankara City Hospital with the complaint of pain and burning sensation in the hands and feet and received a pre-diagnosis of polyneuropathy based on electroneuromyography (ENMG). Biochemistry and hormone parameters of patients were scanned retrospectively.
Result: A total of 116 patients, 49 (42.2%) female and 67 (57.8%) male, were included in the study. When the patients were divided into three groups according to the tertiles of HbA1C, the frequency of polyneuropathy was significantly higher in the group with high HbA1C levels (P=0.004). A significant relationship was observed between the magnesium level and detection of polyneuropathy on ENMG The mean magnesium level was significantly lower in the polyneuropathy group(P=0.013). Patients with additional complications other than polyneuropathy had significantly lower magnesium levels than those without such complications (P=0.021).
Conclusion: This study showed that the magnesium levels were significantly associated with the development of polyneuropathy in patients with type 2 DM. It was concluded that an adequate magnesium level in patients with glycemic control can prevent the development of diabetic polyneuropathy.
References
- 1. Davies M, Brophy S, Williams R, Taylor A. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care. 2006;29(7):1518.
- 2. Ziegler D, Rathmann W, Dickhaus T, Meisinger C, Mielck A, KORA Study Group. Neuropathic pain in diabetes, prediabetes and normal glucose tolerance: the MONICA/KORA Augsburg Surveys S2 and S3. Pain Med. 2009;10(2):393.
- 3. Young RJ, Ewing DJ, Clarke BF. Chronic and remitting painful diabetic polyneuropathy. Correlations with clinical features and subsequent changes in neurophysiology. Diabetes Care. 1988;11(1):34-40.
- 4. Siddiqui K, Bawazeer N, Joy SS. Variation in macro and trace elements in progression of type 2 diabetes. Scientific World Journal. 2014;461591.
- 5. Gommers LM, Hoenderop JG, Bindels RJ, de Baaij JH. Hypomagnesemia in type 2 diabetes: A vicious circle? Diabetes. 2016;65(1):3–13.
- 6. Pham PC, Pham PM, Pham SV, Miller JM, Pham PT. Hypomagnesemia in patients with type 2 diabetes. Clin J Am Soc Nephrol. 2007;2(2):366–373.
- 7. Pokharel DR, Khadka D, Sigdel M, Yadav NK, Kafle R, Sapkota RM, et al. Association of serum magnesium level with poor glycemic control and renal functions in Nepalese patients with type 2 diabetes mellitus. Diabetes Metab Syndr. 2017;Suppl 1:417–423.
- 8. Agrawal P, Arora S, Singh B, Manamalli A, Dolia PB. Association of macrovascular complications of type 2 diabetes mellitus with serum magnesium levels. Diabetes Metab Syndr. 2011;5(1):41–44.
- 9. Wayner DD, Burton GW, Ingold KU, Locke S. Quantitative measurement of the total, peroxyl radical-trapping antioxidant capability of human blood plasma by controlled peroxidation. The important contribution made by plasma proteins. FEBS Lett. 1985;187(1):33–37.
- 10. Halliwell B. Albumin—an important extracellular antioxidant? Biochem Pharmacol. 1988;37(4):569–571.
- 11. Roche M, Rondeau P, Singh NR, Tarnus E, Bourdon E. The antioxidant properties of serum albumin. FEBS Lett. 2008;582(13):1783–1787.
- 12. Peng F, Yang Y, Liu J, Jiang Y, Zhu C, Deng X, et al. Low antioxidant status of serum uric acid, bilirubin and albumin in patients with neuromyelitisoptica. Eur J Neurol. 2012;19(2):277–283.
- 13. Ghafourifar P, Mousavizadeh K, Parihar MS, Nazarewicz RR, Parihar A, Zenebe WJ. Mitochondria in multiple sclerosis. Front Biosci. 2008;13:3116–3126.
- 14. Fuhua P, Xuhui D, Zhiyang Z, Ying J, Yu Y, Feng T, et al. Antioxidant status of bilirubin and uric acid in patients with myasthenia gravis. Neuroimmunomodulation. 2012;19(1):43–49.
- 15. Su Z, Chen Z, Xiang Y, Wang B, Huang Y, Yang D, et al. Low serum levels of uric acid and albumin in patients with Guillain–Barre syndrome. Medicine. 2017;96(15):e6618.
- 16. Smilde TDJ, Van Veldhuisen DJ, Navis G, Voors AA, Hillege HL. Drawbacks and prognostic value of formulas estimating renal function in patients with chronic heart failure and systolic dysfunction. Circulation. 2006;114(15):1572–1580.
- 17. Genuth S. Insights from the diabetes control and complications trial/epidemiology of diabetes interventions and complications study on the use of intensive glycemic treatment to reduce the risk of complications of type 1 diabetes. Endocr Pract. 2006;Suppl 1:34-41.
- 18. Janghorbani M, Rezvanian H, Kachooei A, Ghorbani A, Chitsaz A, Izadi F, et al. Peripheral neuropathy in type 2 diabetes mellitus in Isfahan, Iran: prevalence and risk factors. Acta Neurol Scand. 2006;114(6):384-391.
- 19. Palmer BF, Clegg DJ. Electrolyte and acid-base disturbances in patients with diabetes mellitus. N Engl J Med. 2015;373(6):548-559.
- 20. Song Y, Manson JE, Buring JE, Liu S. Dietary magnesium intake in relation to plasma insulin levels and risk of type 2 diabetes in women. Diabetes Care. 2004;27(1):59-65.
- 21. Chung T, Prasad K, Lloyd TE. Peripheral neuropathy: clinical and electrophysiological considerations. Neuroimaging Clin N Am. 2014; 24(1):49-65.
- 22. Zhang Qi, Ji L, Zheng H, Li Q, Xiong Q, Sun W, et al. Low serum phosphate and magnesium levels are associated with peripheral neuropathy in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract. 2018;146:1–7.
- 23. Chu C, Zhao W, Zhang Y, Li L, Lu J, Jiang L, et al. Low serum magnesium levels are associated with impaired peripheral nerve function in type 2 diabetic patients. Sci Rep. 2016;6:32623.
- 24. Crescenzso R, Bianco F, Mazzoli A, Giacco A, Liverini G, Iossa S. Mitochondrial efficiency and insulin resistance. Front Physiol. 2014;5:512.
- 25. Rodriguez-Moran M, Guerrero-Romero F. Oral magnesium supplementation improves insulin sensitivity and metabolic control in type 2 diabetic subjects: a randomized double-blind controlled trial. Diabetes Care. 2003;26(4):1147-1152.
- 26. Razzaghi R, Pidar F, Momen-Heravi M, Bahmani F, Akbari H, Asemi Z. Magnesium supplementation and the effects on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. Biol Trace Elem Res. 2018;181(2): 207-215.
- 27. Arfuzir NN, Lambuk L, Jafri AJ, Agarwal R, Iezhitsa I, Sidek S, et al. Protective effect of magnesium acetyltaurate against endothelin-induced retinal and optic nerve injury. Neuroscience. 2016;325:153-164.
28. Corsonello A, Ientile R, Buemi M, Cucinotta D, Mauro VN, Macaione S, et al. Serum ionized magnesium levels in type 2 diabetic patients with microalbuminuria or clinical proteinuria. Am J Nephrol. 2000;20(3):187-192.
- 29. Wang S, Hou X, Liu Y, Lu H, Wei L, Bao Y, et al. Serum electrolyte levels in relation to macrovascular complications in Chinese patients with diabetes mellitus. Cardiovasc Diabetol. 2013;12:146.
- 30. Hamdan HZ, Nasser NM, Adam AM, Saleem MA, Elamin MI. Serum magnesium, iron and ferritin levels in patients with diabetic retinopathy attending Makkah Eye Complex, Khartoum, Sudan. Biol Trace Elem Res. 2015;165(1):30-34.
- 31. Sharma A, Dabla S, Agrawal RP, Barjatya H, Kochar DK, Kothari RP. Serum magnesium: An early predictor of course and complications of diabetes mellitus. J Indian Med Assoc. 2007;105(1):16-20.
- 32. Suhail M. Na, K-ATPase: Ubiquitous multifunctional transmembrane protein and its relevance to various pathophysiological conditions. J Clin Med Res. 2010;2(1):1–17.
- 33. Grafton G, Baxter MA. The role of magnesium in diabetes mellitus. A possible mechanism for the development of diabetic complications. J Diabetes Complications. 1992;6(2):143–149.
- 34. Iwasaki T, Togashi Y, Terauchi Y. Significant association of serum albumin with severity of retinopathy and neuropathy, in addition to that of nephropathy, in Japanese type 2 diabetic patients. Endocr J. 2008;55(2):311-316.