AİLE HEKİMLERİ VE İÇ HASTALIKLARI HEKİMLERİNİN TAKVİYE VE TEDAVİ AMAÇLI MAGNEZYUM KULLANIMINA İLİŞKİN BİLGİ VE DAVRANIŞLARI

Abstract

Amaç: Bu çalışmanın amacı, aile hekimleri ve iç hastalıkları hekimlerinin magnezyum kullanım endikasyonlarını ve hekimlerin magnezyum preparatlarının içerdiği magnezyum formlarına ilişkin bilgi ve davranışlarını belirlemektir. Yöntem: Tanımlayıcı tipteki çalışmamız 18 Ocak 2023 ile 20 Nisan 2023 tarihleri arasında Google-Forms üzerinden online olarak gerçekleştirilmiştir. Araştırmanın evrenini Ankara'daki aile hekimleri (pratisyen, asistan ve uzmanlar) ve iç hastalıkları hekimleri (asistan ve uzmanlar) oluşturmuştur. Araştırmamızda tüm hekimlere ulaşılmaya çalışılmış olup, örneklem hesaplaması yapılmamıştır. Anketimizde 15 soru bulunmaktadır. Bulgular: Çalışmamıza katılan hekimlerin yaş ortalaması 30.47±4.94 yıl (min=25, max=48) ve %62.2'si kadındı. Katılımcıların %69,7'si aile hekimi, %30,3'ü iç hastalıkları hekimi, %77,3'ü araştırma görevlisi ve %22,7'si uzman hekimdi. Magnezyum tedavisi için en yaygın endikasyonlar kas krampları (%89,1) ve hipomagnezemi (%87,4), en yaygın kullanılan preparatlar ise magnezyum oksit (%79,8) ve magnezyum sülfat (%32,8) idi. Kendisi magnezyum kullanan hekimler en sık kramp (%32,4) ve uykusuzluk (%13,5) endikasyonları ile, en sık magnezyum oksit (%26,3), magnezyum sitrat+malat+glisinat (%13,1) ve magnezyum biglisinat (%13,1) preparatlarını kullanmaktaydı. Beş yıldan uzun süredir çalışan hekimler, beş yıl veya daha kısa süredir çalışan hekimlere kıyasla hastalara daha sık magnezyum reçete etmekte (p=0,010), hasta ve yakınlarına daha sık magnezyum takviyesi önermekte (p=0,020) ve kendileri daha sık magnezyum takviyesi kullanmaktaydı (p=0,025). Uzman hekimlerin asistan hekimlere kıyasla hastaların vitamin-mineral takviyesi kullanımını daha fazla sorguladığı (p=0,044) ve hastalarına daha fazla magnezyum takviyesi önerdiği (p=0,001) tespit edildi. Aile hekimlerinin hastaların kullandığı magnezyumu, dahiliye hekimlerine göre daha fazla reçete ettiği (p<0,001) ve hastalara magnezyumdan zengin beslenmeyi ile ilgili daha çok bilgi verdiği (<0,001) bulundu. Sonuç: Çalışmamıza katılan hekimler, hastaları için sosyal güvenlik kurumu geri ödeme kapsamında olan magnezyum preparatlarını tercih ederken, kendi kullanımları için biyoyararlanımı daha yüksek olan formları tercih etmişlerdir. Aile hekimlerinin dahiliye hekimlerine göre hastalarına daha fazla magnezyumdan zengin beslenme önerilerinde bulundukları ve hastaların kullandığı magnezyumu daha sık reçete ettikleri görülmüştür.

Keywords

• Magnezyum
• beslenme
• besin takviyesi.

KNOWLEDGE AND BEHAVIORS OF FAMILY PHYSICIANS AND INTERNAL MEDICINE PHYSICIANS REGARDING THE USE OF MAGNESIUM FOR SUPPLEMENTATION AND TREATMENT

Abstract

Objective: To identify indications for magnesium use and assess physicians' knowledge of different formulations of magnesium in medication and supplements Method: A descriptive study was conducted online via Google Forms between January 18 and April 20, 2023. The study population consisted of family physicians (general practitioners, residents, and specialists) and internal medicine physicians (residents and specialists) in Ankara. All physicians were attempted to be reached, and no sampling calculation was made. The survey consisted of 15 questions. Results: A total of 119 physcians completed the survey. The mean age of the physicians who participated in our study was 30.47±4.94 years (min=25, max=48) and 62.2% were female. Of them, 69.7% were family physicians, 30.3% were internal medicine physicians, 77.3% were research assistants and 22.7% were specialists. The most common indications for magnesium treatment were muscle cramps (89.1%) and hypomagnesemia (87.4%); the most commonly used preparations were magnesium oxide (79.8%) and magnesium sulfate (32.8%). The most common indications of using magnesium were cramps (32.4%) and insomnia (13.5%); the most frequently used preparations were magnesium oxide (26.3%), magnesium citrate+malate+glycinate (13.1%), and magnesium biglycinate (13.1%). Physicians who had been practicing for more than 5 years prescribed magnesium more (p=0.010), recommended magnesium supplements more (p=0.020), and used magnesium supplements themselves more (p=0.025) than physicians who had been practicing for 5 years or less. It was found that specialists questioned patients' use of vitamin-mineral supplements more (p=0.044) and recommended magnesium supplements more (p=0.001) than residents. It was found that family physicians prescribed the magnesium used by patients more (p<0.001) and recommended more magnesium-rich nutrition to patients (<0.001) than internal medicine physicians. Conclusion: The physicians who participated in our study preferred magnesium forms covered by social security institution reimbursement for their patients, whereas they preferred forms with higher bioavailability for their own use. It was observed that family physicians provided more magnesium-rich dietary recommendations and prescribed the magnesium used by the patients than internal medicine physicians.

Keywords

• Magnesium
• nutrition
• dietary supplement

References

1. 1. de Baaij JH, Hoenderop JG, Bindels RJ. Magnesium in man: implications for health and disease. Physiol Rev. 2015; 95 (1): 1-46.
2. 2. Türkiye Beslenme Rehberi (TÜBER) 2015. T.C. Sağlık Bakanlığı Yayın No: 1031: 35. Ankara 2016. Website: https://dosyasb.saglik.gov.tr/Eklenti/10915,tuber-turkiye-beslenme-rehberipdf.pdf (accessed 06/11/2023) (in Turkish)
3. 3. United States Department of Agriculture (USDA). Agricultural Research Service. 2019. Usual Nutrient Intake from Food and Beverages, by Gender and Age, What We Eat in America, NHANES 2013-2016. Website: https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/usual/Usual_Intake_gender_WWEIA_2013_2016.pdf (accessed 10/11/2023).
4. 4. Türkiye Beslenme Rehberi (TÜBER) 2022. Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü. Sağlık Bakanlığı Yayın No:1031: 321. Ankara 2022. Website: https://hsgm.saglik.gov.tr/depo/birimler/saglikli-beslenme-ve-hareketli-hayat-db/Dokumanlar/Rehberler/Turkiye_Beslenme_Rehber_TUBER_2022_min.pdf (accessed 11/06/2023) (in Turkish)
5. 5. Food Supplement and Nutrition Association. Food supplement use and nutritional habits measurement survey- December 2020. (Online) Website: https://gtbd.org.tr/gida-takviyesi-kullanimi-ve-beslenme-aliskanliklari-olcumu-anketi-2/ (accessed 11/06/2023) (in Turkish)
6. 6. Savlak N, Çağındı Ö, Dedeoğlu M, İnce C, Köse E. An overview of the dietary supplements in Türkiye and the world. The Journal of FOOD. 2022; 47 (4), (in Turkish). https://doi.org/10.15237/gida.GD22021
7. 7. Özdemir, D. C., Akarsu, B., Başer, D. A., Fidanci, İ., Aksoy, H., & Cankurtaran, M. Evaluation of Adults’ Attitudes, Behaviors and Related Factors on Use of Nutritional Support in the COVID-19 Pandemic: A Descriptive Study. Turkiye Klinikleri Journal of Health Sciences. 2022; 7 (2): 307-319. https://doi.org/10.5336/healthsci.2021-85276
8. 8. United States Department of Agriculture (USDA). National Nutrient Database for Standard Reference Release 28. Website: https://ods.od.nih.gov/pubs/usdandb/magnesium-content.pdf (accessed 11/06/2023)

9. 9. Ranade V, Somberg J. Bioavailability and pharmacokinetics of magnesium after administration of magnesium salts to humans. American journal of therapeutics. 2001; 8 (5): 345-57. https://doi.org/10.1097/00045391-200109000-00008
10. 10. Blancquaert L, Vervaet C, Derave W. Predicting and testing bioavailability of magnesium supplements. Nutrients. 2019; 11 (7): 1663. https://doi.org/10.3390/nu11071663
11. 11. Walker AF, Marakis G, Christic S, Byng M. Mg citrate found more bioavailable than other Mg preparations in a randomised, double-blind study. Magnesium research. 2003; 16 (3): 183-91. PMID: 14596323.
12. 12. Mühlbauer B, Schwenk M, Coram WM, Antonin KH, Etienne P, et al. Magnesium-L-aspartate-HCl and magnesium-oxide: bioavailability in healthy volunteers. Eur J Clin Pharmacol. 1991; 40 (4): 437-8. doi: 10.1007/BF00265863.
13. 13. Schuette SA, Lashner BA, Janghorbani M. Bioavailability of magnesium diglycinate vs magnesium oxide in patients with ileal resection. Journal of Parenteral and Enteral Nutrition. 1994; 18 (5): 430-5. https://doi.org/10.1177/0148607194018005430
14. 14. Abbasi B, Kimiagar M, Sadeghniiat K, Shirazi MM, Hedayati M, et al. The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2012; 17 (12): 1161. PMID: 23853635
15. 15. Quaranta S, Buscaglia M, Meroni M, Colombo E, Cella S. Pilot study of the efficacy and safety of a modified-release magnesium 250mg tablet (Sincromag®) for the treatment of premenstrual syndrome. Clinical drug investigation. 2007; 27: 51-8. https://doi.org/10.2165/00044011-200727010-00004
16. 16. ELDerawi WA, Naser IA, Taleb MH, Abutair AS. The effects of oral magnesium supplementation on glycemic response among type 2 diabetes patients. Nutrients. 2018; 11 (1): 44. https://doi.org/10.3390/nu11010044
17. 17. Qu Q, Rong R, Yu J. Effect of magnesium supplementation on pregnancy outcome in gestational diabetes mellitus patients: A meta‐analysis of randomized controlled trials. Food Science & Nutrition. 2022; 10 (10): 3193-202. https://doi.org/10.1002/fsn3.2561
18. 18. Zhang X, Li Y, Del Gobbo LC, Rosanoff A, Wang J, et al. Effects of magnesium supplementation on blood pressure: a meta-analysis of randomized double-blind placebo-controlled trials. Hypertension. 2016; 68 (2): 324-33. https://doi.org/10.1161/HYPERTENSIONAHA.116.07664
19. 19. Houston M. The role of magnesium in hypertension and cardiovascular disease. Journal of Clinical Hypertension. 2011; 13 (11): 843-7. https://doi.org/10.1111/j.1751-7176.2011.00538.x