Influence of magnesium status and magnesium intake on the blood glucose control in patients with type 2 diabetes

doi:10.1016/j.clnu.2010.12.011

Clinical Nutrition

Volume 30, Issue 3, June 2011, Pages 359-364

https://doi.org/10.1016/j.clnu.2010.12.011 Get rights and content

Summary

Background & aims

This study was undertaken to assess magnesium intake and magnesium status in patients with type 2 diabetes, and to identify the parameters that best predict alterations in fasting glucose and plasma magnesium.

Methods

A cross-sectional study was carried out in patients with type 2 diabetes (n = 51; 53.6 ± 10.5 y) selected within the inclusion factors, at the University Hospital Onofre Lopes. Magnesium intake was assessed by three 24-h recalls. Urine, plasma and erythrocytes magnesium, fasting and 2-h postprandial glucose, HbA1, microalbuminuria, proteinuria, and serum and urine creatinine were measured.

Results

Mean magnesium intake (9.37 ± 1.76 mmol/d), urine magnesium (2.80 ± 1.51 mmol/d), plasma magnesium (0.71 ± 0.08 mmol/L) and erythrocyte magnesium (1.92 ± 0.23 mmol/L) levels were low. Seventy-seven percent of participants presented one or more magnesium status parameters below the cut-off points of 3.00 mmol/L for urine, 0.75 mmol/L for plasma and 1.65 mmol/L for erythrocytes. Subjects presented poor blood glucose control with fasting glucose of 8.1 ± 3.7 mmol/L, 2-h postprandial glucose of 11.1 ± 5.1 mmol/L, and HbA1 of 11.4 ± 3.0%. The parameters that influenced fasting glucose were urine, plasma and dietary magnesium, while plasma magnesium was influenced by creatinine clearance.

Conclusions

Magnesium status was influenced by kidney depuration and was altered in patients with type 2 diabetes, and magnesium showed to play an important role in blood glucose control.

Introduction

Magnesium is an essential mineral for the human body, principally because of its role in the regulation of cellular processes and its function as a cofactor in a wide range of metabolic reactions. Many enzymes that catalyze phosphorylation and dephosphorylation reactions, including those involved in glycolysis, are activated by the formation of MgATP⁺² complexes, which are the real substrates for these enzymes.1, 2

Alterations in the distribution of magnesium within the body have been associated with several diseases and especially diabetes, a disorder representing a global public health problem of increasingly serious concern.3, 4 Although some epidemiological studies have suggested that adequate magnesium intake reduces the risk of development of type 2 diabetes, there are still contradictions with respect to the role of low magnesium intake as a predictor factor for this disease.5, 6, 7, 8, 9, 10 The importance of magnesium for individuals with diabetes can be explained on the basis of maintenance of glucose homeostasis along with activation of the factors involved in sensitivity of tissues to insulin, the receptors of which are phosphorylated only in the presence of MgATP⁺².2, 11

Some studies have shown that the magnesium intake by patients with diabetes is often below recommended levels.12, 13 Additionally, there is evidence that the magnesium status of patients with diabetes tends to alter, and that low body concentrations of this mineral may influence the evolution of the disease and generate further complications.14, 15, 16, 17

Despite reports describing the occurrence of hypomagnesemia among patients with diabetes,18, 19 few investigations have considered dietary intake of magnesium in the Brazilian population, and none has examined the levels of magnesium in patients with type 2 diabetes. Hence, the aim of the present study was to evaluate the intake of magnesium and the levels of the mineral in urine, plasma and erythrocytes in subjects with type 2 diabetes. Additionally, attempts were made to identify those parameters that best predict alterations in fasting glucose and plasma magnesium.

Section snippets

Materials and methods

The study was approved by the Ethics Committees on Research of the University Hospital Onofre Lopes (HUOL, Natal, RN, Brazil) and of the Faculty of Pharmaceutical Sciences, University of São Paulo (protocol CAAE # 0005.0.294.018-06). Written informed consent was obtained from all participants prior to the commencement of the study.

Results

The baseline characteristics of the study population (n = 51) are shown in Table 1. The main drugs prescribed were oral antidiabetic biguanides alone (metformin; 66.7%), followed by sulfonylureas alone (31.4%) and a metformin–glibenclamide combination (3.9%), while the antihypertensive drugs used were hydrochlorothiazide (23.5%) and captopril (45.1%). Half of the patients (51.0%) received insulin treatment, often accompanied by antihyperglycemic drugs such as metformin (29.4%), sulfonylurea

Discussion

The results presented here show that magnesium intake by the study population was inadequate and that a high percentage of individuals presented alterations in the status of this mineral. The concentration of plasma magnesium was inversely correlated with fasting and 2-h postprandial glucose, whereas the level of urine magnesium was directly associated with fasting glucose. Moreover, as shown by discriminant analyses, the glycemic levels of patients with type 2 diabetes were influenced by

Sources of funding

The study was financially supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP; process #2006/05601-9), the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq; process #135858/2006-2, 480487/2009-0), the Ministério da Saúde do Brasil and the Fundação de Apoio à Pesquisa do Estado do Rio Grande do Norte (FAPERN; process PPSUS/2007 #175_19969779).

Statement of authorship

We hereby certify that it is an original publication. This manuscript is not currently under consideration or in press elsewhere.

The contributions of the authors to the manuscript are as follows. C.H.S. contributed to the conception and design of the study, acquisition of data, samples analyses, statistical analysis, analysis and data interpretation, drafting the article and revising it critically for important intellectual content. L.F.C.P. contributed to the conception and design of the study

Conflict of interest

None of the authors do have any potential conflicts of interest that could inappropriately influence in this work.

Acknowledgments

The authors are grateful to the director of the HUOL and all of the participants for their valuable collaboration. Particular thanks go to Prof. Maria das Graças Almeida, Ana Rachel F. Barbosa and Luzia L. S. Fernandes, from the Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, for technical assistance with laboratory analyses, and to Prof. Julia Maria P. Soler, from the Institute of Mathematics and Statistics, University of São Paulo, for help with

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Citation Excerpt :
The possible explanation of these results is that vegetables, fruits, and cereals are a good source of antioxidants mainly polyphenols and fibers, in addition to the significant amount of magnesium, calcium, potassium and having a limited amount of sodium, which play an important role in IR in all age groups [54]. For instance, individuals with low levels of serum magnesium have impaired blood sugar levels [55]; it has been found that the lack of magnesium can result in disordered transfer of the cellular glucose, which influencing in insulin signaling pathways or even reducing the pancreatic secretion of insulin [56]. Furthermore, a high amount of sodium intake has been associated with IR and MS development in adults [57].
This study aims to examine the associations of food portion size (PS) with markers of insulin resistance (IR) and clustered of metabolic risk score in European adolescents.
A total of 495 adolescents (53.5% females) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study were included. The association between PS from food groups and homeostasis model assessment of insulin resistance (HOMA-IR) index, VO2 max, and metabolic risk score was assessed by multilinear regression analysis adjusting for several confounders. Analysis of covariance (ANCOVA) was used to determine the mean differences of food PS from food groups by HOMA-IR cutoff categories by using maternal education as a covariable.
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^☆: Conference presentation: Part of this study was presented orally at the 10th National Congress of the Brazilian Food and Nutrition Society (São Paulo, Brazil, September 2009), at the XVII Congress of the Brazilian Diabetes Society (Fortaleza, Brazil, November 2009) and at the XV Congress of the Latin American Nutrition Society (Santiago, Chile, November 2009), and their abstracts were published in the Book of Abstracts.

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Original ArticleInfluence of magnesium status and magnesium intake on the blood glucose control in patients with type 2 diabetes☆

Summary

Background & aims

Methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Sources of funding

Statement of authorship

Conflict of interest

Acknowledgments

Clin Nutr

Am J Clin Nutr

J Am Diet Assoc

J Clin Epidemiol

Am J Clin Nutr

Hypomagnesemia and hypermagnesemia

Rev Endocr Metab Disord

Intracellular magnesium and insulin resistance

Magnes Res

Nutrition recommendations and interventions for diabetes

Diabetes Care

Serum and dietary magnesium and the risk for type 2 diabetes mellitus: the atherosclerosis risk in communities study

Arch Intern Med

Magnesium intake and risk of type 2 diabetes in men and women

Diabetes Care

Dietary calcium and magnesium, major food sources, and risk of type 2 diabetes in U.S. black women

Diabetes Care

Magnesium intake in relation to systemic inflammation, insulin resistance, and the incidence of diabetes

Diabetes Care

Magnesium intake and type II diabetes in Japanese men and women: the Japan Public Health Center-based prospective study

Eur J Clin Nutr

Impaired tyrosine-kinase activity of muscle insulin receptors from hypomagnesaemic rats

Diabetologia

Original Article
Influence of magnesium status and magnesium intake on the blood glucose control in patients with type 2 diabetes☆