Original article
Clinical
Depressive Symptoms and Hypomagnesemia in Older Diabetic Subjects

https://doi.org/10.1016/j.arcmed.2007.03.008Get rights and content

Background

We undertook this study to assess the hypothesis that hypomagnesemia is associated with depressive symptoms in older people with diabetes.

Methods

A total of 55 type 2 diabetic patients, aged 65 years or older, with depressive symptoms were compared with a control group of diabetic subjects without depressive symptoms in an age- and gender-matched case/control study. A score ≥11 points in the Yesavage's scale was used for defining depressive symptoms, and hypomagnesemia was defined by serum magnesium levels <0.74 mmol/L. Well-known causes for depression as well as diseases and drugs that may cause depressive symptoms or hypomagnesemia were exclusion criteria.

Results

Serum magnesium levels were significantly lower among depressive than control diabetic subjects (0.74 ± 0.25 vs. 0.86 ± 0.29 mmol/L, p = 0.02). Twenty four (43.6%) and 7 (12.7%) individuals in the case and control group exhibited low serum magnesium levels (p = 0.0006). The adjusted logistic regression analysis showed an independent association between hypomagnesemia and depressive symptoms (OR 1.79; CI95% 1.1–6.9, p = 0.03).

Conclusions

Our results suggest that hypomagnesemia is independently associated with depressive symptoms in older people with diabetes.

Introduction

Depression is a frequent psychiatric disorder (1) that reaches a prevalence of 39% in older people with diabetes (2). In addition to the well-known causes for depression in older people (1), diabetes also contributes to development of depression, increasing the risk for poor outcomes.

Magnesium, the second most abundant intracellular cation (3), is a critical cofactor in many enzymatic reactions of carbohydrate metabolism, protein synthesis, and modulation of glucose transport across cell membranes 4, 5, 6. Among older people, changes in mineral bioavailability as well as imbalances between magnesium intake and recommended dietary allowance are common (7). Furthermore, other well-known causes for hypomagnesemia such as use of diuretics and non-controlled diabetes (8) also are frequent in an older population 4, 9. Therefore, hypomagnesemia is usual in older people, especially among institutionalized, diabetic, or hypertensive individuals (8).

In addition to its deleterious effect on blood pressure and glucose metabolism 10, 11, hypomagnesemia also is related to psychiatric disorders, although psychiatric symptoms of hypomagnesemia are nonspecific, ranging from apathy to psychosis 12, 13. Despite the high prevalence of both depression and hypomagnesemia in older people with diabetes that reaches 31.1% (14) and 20% (15), respectively, reports exploring the relationship between hypomagnesemia and depression are scarce 12, 16, 17. To the best of our knowledge there are no previous reports on the association between hypomagnesemia and depression in an older population with diabetes. This study was carried out to assess the hypothesis that hypomagnesemia is associated with depressive symptoms in older diabetic subjects.

Section snippets

Materials and Methods

After previous approval by the Mexican Social Security Institute (IMSS) Research Committee and after obtaining informed consent from all patients, a case-control study was performed. Type 2 diabetic outpatients, aged 65 years or older, were enrolled from the Primary Level Medical Care offices of the IMSS in Durango, a city in northern Mexico. Subjects with depressive symptoms were considered as cases and compared with an age- and gender-matched control group of diabetic subjects without

Results

A total of 865 type 2 diabetic subjects were screened. Among them, the prevalence of depressive symptoms and hypomagnesemia was 39.8% (344/865) and 26.7% (229/865). Only 140 (16.2%) subjects fulfilled the inclusion/exclusion criteria. The major reasons for exclusion were previous diagnosis of depression, hypomagnesemia, use of diuretics, hypothyroidism, renal failure, and physical incapacity due to diabetic complications (blindness and amputation). A total of nine individuals were not included

Discussion

Depression is common among older people with diabetes 21, 22, contributing to elevated costs of medical care and lack of adherence to treatment (22). In addition, because of the common use of diuretics and the customary intake of magnesium under the recommended dietary allowance (15), hypomagnesemia is frequent in older people with diabetes. On this concern, prevalence of hypomagnesemia in the screened population and subjects with depressive symptoms was 26.7% and 43.6%, respectively. Although

Acknowledgments

This work was supported by grants from the National Science and Technology Council of Mexico (SIVILLA 20020402014), the Research Promotion Fund of the Mexican Social Security Institute (FP 2002/368), and the Mexican Social Security Institute Foundation, Civil Association.

References (32)

  • M.P. Vaquero

    Magnesium and trace elements in the elderly: intake, status and recommendations

    J Nutr Health Aging

    (2002)
  • G.E. Levin et al.

    Tissue magnesium status in diabetes mellitus

    Diabetologia

    (1981)
  • J.G. Gums

    Magnesium in cardiovascular and other disorders

    Am J Health Syst Pharm

    (2004)
  • H.H. Rasmussen et al.

    Depression and magnesium deficiency

    Int J Psychiatry Med

    (1989)
  • G.K. Kirov et al.

    Plasma magnesium levels in a population of psychiatric patients: correlations with symptoms

    Neuropsychobiology

    (1994)
  • S.A. Black

    Increased health burden associated with comorbid depression in older diabetic Mexican Americans

    Diabetes Care

    (1999)
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