Magnesium (Mg) has a critical role in the actions of important enzymes and is the fourth most abundant cation in the human body. Magnesium is a cofactor in the glucose-transporting mechanism of the cell membrane and various enzymes in carbohydrate oxidation. It is also involved at multiple levels in insulin secretion, binding and activity. The almost universal involvement of magnesium in a wide variety of cellular processes critical to glucose metabolism, insulin action and cardiovascular functions has been well appreciated.¹ Mg also plays an important role in the phosphorylation reactions of glucose and its metabolism. Mg also plays an important role in the phosphorylation reactions of glucose and its metabolism. Mg and Type 2 Diabetes mellitus (DM) have a close relationship.  Its deficiency has been implicated in insulin resistance, carbohydrate intolerance, dyslipidemia, and complications of diabetes. Approximately one-third of subjects with Type 2 DM have hypomagnesemia mainly caused by enhanced renal excretion. Mg deficiency is associated with poor glycemic control and Mg supplementation improves insulin sensitivity.² It is claimed that there is an inverse relationship between Mg intake and incidence of diabetes mellitus (DM).³ Mg deficiency is common in diabetic patients. The incidence of hypomagnesemia varies between 11 and 47.7%.⁴ Compared with the control group, incidence of hypomagnesemia in newly diagnosed diabetes is 10.5-fold and in patients with previously diagnosed diabetes is 8.5-fold more common.

AIM AND OBJECTIVES

The aim of the study is to assess association of Hypomagnesemia with Diabetic Neuropathy.

1. To estimate the prevalence of hypomagnesemia in patients with diabetes mellitus
2. To correlate the serum magnesium concentration with micro vascular complication of diabetes mellitus such as neuropathy.

This Cross-sectional Observational study was carried out in The Department of General Medicine, MG Medical College and Research Centre, Jaipur. This study was conducted from June 2023 to Oct 2024.

Study population: Patients presenting with Type 2 DM attending the OPD, casualty or admitted in various wards of MG Medical College and Research Centre, Jaipur. 150 Cases (Known Cases- Type 2 Diabetes mellitus   patients). Sample size was calculated at 95% confidence interval and taking 10% absolute allowable error. Nerve conduction velocity

NCS is noninvasive, standardized, and objective, and the most useful electrodiagnostic test for assessing the dysfunction of large myelinated sensory and motor nerve fibers. They are included in the clinical diagnosis of polyneuropathy. Nerve conduction investigations may be used to diagnose neuropathy, whether demyelinating or axonal.

INCLUSION and EXCLUSION CRITERIA

Patients diagnosed with Diabetes Mellitus type 2 In Medicine Department in Mahatma Gandhi Hospital Jaipur. Age 18 years to 75 years

Exclusion criteria

1. Chronic Diarrhea
2. Malabsorption
3. Patients on Diuretics
4. Patients with Renal Failure
5. Patients receiving magnesium supplements or magnesium containing antacid
6. Pregnant females

Out of 150 cases 111 cases have normal magnesium level and 39 found to have hypomagnesemia. Out of 150 cases 127 cases belonged to male sex and 23 cases belonged to female sex. Out of 39 cases in hypomagnesemia group 36 cases belonged to male sex and 3 cases belonged to female sex whereas out of 111 cases in normal magnesium level group 91 cases belonged to male sex and 20 cases belonged to female sex and the two groups were comparable on parameter of sex distribution. Out of 150 cases 53 cases have neuropathy.

Table: 1 Gender profile of cases as per Magnesium status

Graph 1 Magnesium profile of cases

Table 2. NEUROPATHY PROFILE OF CASES

Above table shows that out of 150 cases 53 cases have neuropathy.

Table 3. Association of neuropathy and magnesium levels

Above table shows that the out of 39 cases in hypomagnesemia group 32 cases have Neuropathy and out of 111 cases in normal magnesium level group only 21 cases have Neuropathy i.e. the prevalence of Neuropathy was statistically higher in hypomagnesemia group as compared to normal magnesium level group.

Magnesium plays an important role in the carbohydrate metabolism, it regulates rate-limiting enzymes involved in glycolysis, glucose homeostasis, and insulin action including both insulin receptor responses (tyrosine kinases) and the insulin-signaling cascade. Magnesium also regulates cellular glucose metabolism and insulin secretion. Other metabolic processes involving magnesium as a cofactor or directly are lipid metabolism, and protein and nucleic acid synthesis. Magnesium also has a stabilizing role for proteins, nucleic acids, and biological membranes. Due to involvement in multiple metabolic functions, Mg may be an important factor in occurrence of complications.

Hypomagnesemia can be seen in Type 2 DM. It was found that Type 2 DM subjects with hypomagnesemia were more prone for complications.

Diabetes mellitus is the most common disorder among endocrine disorders that are associated with hy- pomagnesemia. So far many studies have shown that Mg levels are lower in diabetic patients.⁵ According to CARDIA Study (Coronary Artery Risk Development in young Adults) there was an inverse relationship between Mg intake and the incidence of diabetes.⁶

Relatively few studies have been performed in past to evaluate association between Magnesium level and diabetic complications in DM-2 patients in Rajasthan in a tertiary care center. The present study was conducted on 150 patients of Diabetes admitted in Department of Medicine, MG Medical College and Hospital, Jaipur, Rajasthan, India.

In present study out of 150 cases 39 cases have low magnesium level-hypomagnesemia group and 111 cases have normal serum magnesium level- Normo-magnesemia group

Similarly Rao and Shariff et al. (2015),⁷ Arpaci D et al.(2015)⁸ and Moradiya K, Muley et al.(2021)⁹ in their study found that the prevalence of Neuropathy, was statistically higher in hypomagnesemia group as compared to Normo-magnesemia group.

One of the possible mechanisms explaining the relation between diabetic complications and Mg deficiency is insulin resistance. Mg can act as a mild calcium antagonist. In patients with Mg deficiency, intracellular calcium is increased. Increased calcium may interrupt response of skeletal muscles and adipocytes to insulin and lead to insulin resistance. Intracellular Mg plays a role in regulating insulin action, insulin-dependent glucose uptake, and vascular tone. Deficiency of Mg can reduce tyrosine-kinase activity, postreceptorial activity and eventually it may contribute to the development of insulin resistance.^10,11 On the other hand, insulin deficiency and resistance can effect tubular reabsorption of Mg.

Serum Mg was found to be inversely associated with the prevalence of neuropathy. Hypomagnesemia was found to be associated with poor glycemic control. Further studies with large sample size are required to prove a definite role of hypomagnesemia in diabetic complications. Large-scale clinical trials are needed in order to determine whether the correction of Mg deficiency could be effective to reduce the incidence of diabetic complications and to further elucidate the association between serum Mg and diabetic complications.

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