Original articleClinicalDepressive Symptoms and Hypomagnesemia in Older Diabetic Subjects
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)
- et al.
Risk factors associated with depression in patients with type 2 diabetes mellitus
Arch Med Res
(2002) - et al.
Complementary therapies for diabetes: the case for chromium, magnesium, and antioxidants
Arch Med Res
(2005) - et al.
Oral magnesium supplementation improves insulin sensitivity in non-diabetic subjects with insulin resistance. A double-blind placebo-controlled randomized trial
Diabetes Metab
(2004) - et al.
Cerebrospinal fluid magnesium and calcium related to amine metabolites, diagnosis, and suicide attempts
Biol Psychiatry
(1985) - et al.
Plasma levels of homovanillic acid, 5-hydroxyindoleacetic acid and cortisol, and serotonin turnover in depressed patients
Prog Neuropsychopharmacol Biol Psychiatry
(2006) - et al.
Clinical presentation of depression in the elderly
Gerontology
(1994) - et al.
Magnesium: metabolism and requirements
Nutr Hosp
(1997) Hypomagnesemia and diabetes mellitus. A review of clinical implications
Arch Intern Med
(1996)Magnesium metabolism in health and disease
Dis Mon
(1988)- et al.
Magnesium and glucose metabolism
Therapie
(1994)
Magnesium and trace elements in the elderly: intake, status and recommendations
J Nutr Health Aging
Tissue magnesium status in diabetes mellitus
Diabetologia
Magnesium in cardiovascular and other disorders
Am J Health Syst Pharm
Depression and magnesium deficiency
Int J Psychiatry Med
Plasma magnesium levels in a population of psychiatric patients: correlations with symptoms
Neuropsychobiology
Increased health burden associated with comorbid depression in older diabetic Mexican Americans
Diabetes Care
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