# Introduction ype 2 diabetes mellitus is metabolic and endocrinological disease characterised by hyperglycemia associated with both insulin resistance and defective insulin secretion 1 . Type 2 Diabetes mellitus accounts for approximately 90-95% of all diagnosed cases of diabetes 2 . In addition to hyperosmolar coma and ketoacidosis, patients with type 2 diabetes mellitus may have cardiovascular disease, nephropathy, retinopathy and polyneuropathy 3 . Magnesium is the fourth most abundant cation in the human body and the second most abundant intracellular cation 4 . It plays an important role in the carbohydrate metabolism. It serves as a cofactor for all enzymatic reactions that require kinases 5 . It is also an essential enzyme activator for neuromuscular excitability and cell permeability, a regulator of ion channels and mitochondrial function, a critical element in cellular proliferation and apoptosis, and an important factor in both cellular and humoral functions 6 . The treatment of the patients of type 2 diabetes mellitus requires a multidisciplinary approach whereby every potential complicating factor must be closely monitored and treated. In particular although hypomagnesaemia has been reported to occur with increased frequency in patients with type 2 diabetes mellitus, it is frequently overlooked and undertreated 7 . The present study was conducted with an objective to evaluate the serum magnesium and fasting blood glucose in type 2 Diabetes mellitus cases and compare them with controls. Very few studies have evaluated the relationship between serum magnesium and modality of treatment in type 2 diabetes mellitus. The present study also attempts to evaluate the possible relationship between the modality of treatment and serum magnesium levels. # II. # Materials And Methods The study was approved by the Ethics committee; a written informed consent was obtained from all participants in this study. A total of 50 patients with type 2 diabetes mellitus were recruited from the institute's medicine department. The diagnosis of type 2 diabetes mellitus was confirmed by biochemical investigations as per WHO criteria 8 . Fifty age and sex matched apparently healthy individuals with normal plasma glucose and with no symptoms suggestive of DM were taken as controls. Patients with acute or chronic diarrheal/ malabsorption states, with thyroid or adrenal dysfunction, history of alcohol intake, history of vitamin or mineral supplements in the recent past, recent metabolic acidosis, pregnancy, lactation, with serum creatinine > 1.5 mg/dl and on drugs known to affect magnesium levels were excluded from the study 9 . Both cases and controls were subjected to estimation of biochemical parameters. Fasting plasma glucose was estimated by using commercially available kit in automated analyzer. Magnesium was estimated by a kit that uses calmagite dye method 10 . The reference serum magnesium level by this method is 1.6-2.5 mg/dl. # III. # Statistical Analysis Statistical analysis of data was performed using SPSS (Version 15.0). Chi-square and Fisher Exact test has been used to find the significance of proportion of serum magnesium levels between cases and controls. Student t test has been used to find the significance of mean pattern of serum magnesium between cases/ controls and Insulin/OHA. IV. # Results A Comparative study consisting of 50 Diabetic Mellitus patients and 50 controls was undertaken to investigate the change pattern of serum magnesium in DM cases when compared to controls. The mean age of the diabetics was 55.42±12.65 years whereas it was 55.58±12.84 years respectively. Both among the cases and controls the sex distribution was same i.e. 62% and 38% males and females respectively. The maximum number of patients was in the age group of 41-50 i.e. 42%. The mean FBS levels among cases and controls were 230.1 mg/dl and 99.42 mg/dl respectively. There is significant difference between levels of serum magnesium levels among diabetics and controls. The mean serum magnesium levels in cases and controls are 1.67 mg/dl and 2.03 mg/dl respectively (p<0.001). Of the total of 50 diabetic patients 25(50%) were on insulin alone, 16(32%) were on OHA'S and 9(18%) were on combination of OHA'S and insulin. The mean serum magnesium levels in the OHA group, insulin group and the insulin+ OHA group were 2.02 mg/dl,1.59mg/dl and 1.25 mg/dl respectively. The serum magnesium levels were significantly lower in the insulin treated group compared to the OHA treated group. Infections were the most common cause for admission accounting for 54% of the admissions among diabetics. The next commonest cause for admission was cardiovascular disease which accounted for 16% of the admissions. Of these 50% were on insulin, 37.5% on OHA's and 12.5% on OHA's and insulin both. Of the cardiovascular disease 3 patients were admitted for stable angina, 3 for unstable angina and 2 for myocardial infarction. Neurological problems accounted for 12% of admissions. 4 patients admitted for stroke, 1 for cranial nerve palsy and 1 for peripheral neuropathy. Peripheral vascular disease accounted 12% of admissions. 4 patients had ischemic signs in the limbs and 2 patients had gangrene. 6% of patients were admitted exclusively for poorly controlled diabetes. V. # Discussion Of all the endocrine and metabolic disorders associated with magnesium deficiency, diabetes mellitus is the most common. Many studies have shown that plasma levels are lower in patients with type1 and type 2 diabetes mellitus compared with non diabetic control subjects. Inverse correlations between magnesium and fasting plasma glucose, HbA1C, HOMA-IR have been observed. 11,12 Factors implicated in hypomagnesemia in diabetics include diets low in magnesium 13 ,osmotic diuresis causing high renal excretion of magnesium, insensitivity to insulin affecting intracellular magnesium transport and thereby causing increased loss of the extracellular magnesium 14 rampant use of loop and thiazides diuretics promoting magnesium wasting, 15,16 diabetic autonomic neuropathies 4 and reduced tubular reabsorption due to insulin resistance 17 . Sometimes the more common use of antibiotics and antifungals such as aminoglycosides and amphotericin in patients with diabetes may also contribute to renal magnesium wasting 18 . Hypomagnesemia may be a contributing factor for the long term complications particularly ischemic heart disease 19 , retinopathy 20,21 , foot ulcer 22 and peripheral neuropathy 23 .In our study there was significant decrease in serum magnesium level in type 2 DM as compared to controls. Similar such decreased in serum magnesium level in diabetic patients as compared to controls has been reported in other studies. 24,25 Our study also demonstrated that serum magnesium levels were significantly lower in patients on insulin treatment compared to patients who were on oral hypoglycaemic agents alone. # VI. # Conclusion Hypomagnesemia, defined herein as having low serum magnesium concentrations, is common among patients with type 2 diabetes. Contributory mechanisms most likely are multifactorial. Because available data suggest that adverse outcomes are associated with hypomagnesemia, it is prudent that routine surveillance for hypomagnesemia is done and the condition be treated whenever possible. A magnesium rich diet consisting of whole grains legumes, fruits and vegetables such as spinach, okra, dry apricots may be recommended. Further studies on the role of magnesium supplementation in type 2 DM in the Indian population are recommended. Volume XIV Issue IV Version I Year ( ) K2![Figure2](image-2.png "Figure 2") 1Year 2014Volume XIV Issue IV Version ID D D D ) K(SerumMagnesiuCasesControlsmRange (Min-Max)1.0-2.501.50-2.60Mean ± SD1.67±0.3 72.03±0.2 595% CI0.052-1.560.04-1.96SignificanceStudent P<0.001t=5.649,© 2014 Global Journals Inc. (US) 3magnesiumSerum Magnesiu mInsulin (n=34)OHA (n=16)Range (Min-Max)1.0-2.201.60-2.50Mean ± SD1.50±0. 272.02±0. 2995% CI1.41-1.601.86-2.18SignificancStudent t=5.988,eP<0.001 © 2014 Global Journals Inc. (US) * Copper and Ceruloplasmin levels in relation to total thiols and GST in type 2 diabetes mellitus patients ASarkar SDash BKBarik MSMuttigi VKedage JKShetty Ind j Clin Biochem 25 2010 * National Diabetes Fact Sheet 2002. February 21. 2005 American Diabetes Association * Hypomagnesemia in patients with type 2 diabetes PCPham PMPham SVPham JMMiller PTPham Clin J Am Soc Nephrol 2 2007 * Magnesium: An update on physiological, clinical and analytical aspects NelSaris EMervaala HKarppanen JAKhawaja ALewenstam Clin Chem Acta 294 2000 * Magnesium and insulindependent diabetes mellitus AElamin TTuvemo Diabetes Res Clin Pract 10 1990 * Serum and dietary magnesium and the risk for type 2 diabetes: The Atherosclerosis Risk in Communities Study WhlKao ARFolsom FJNieto JPMo RLWatson FLBrancati Arch Intern Med 159 1999 * Diabetes Mellitus reports of WHO study group Tech Rep Ser 727 1985 * Hypomagnesemia in type 2 diabetes mellitus ArundhatiDasgupta DiptiSarma Uma KaimalSaikia Indian J Endocrinol Metab 16 6 2012 * Magnesium transport induced ex vivo by a pharmacological dose of insulin is impaired in non-insulin-dependent diabetes mellitus H :Hua JGonzales R: Rude Magnes-Res 8 4 1995 Dec * Magnesium intake in relation to systemic inflammation, insulin resistance, and the incidence of diabetes DJKim PXun KLiu CLoria KYokota DRJacobsJr Diabetes Care 33 2010 * Hypomagnesemia in critically ill medical patients CSLimaye VALondhey MYNadkar NEBorges J Assoc physicians India 59 2011 * Fiber and magnesium intake and incidence of type 2 diabetes: A prospective study and meta-analysis MBSchulze MSchultz CHeidemann ASchienkiewitz KHoffmann HBoeing Arch Intern Med 167 2007 * Insulin induces opposite changes in plasma and erythrocyte magnesium concentrations in normal man GPaolisso SSgambato NPassariello DGiugliano AScheen D'onofrio F Diabetologia 29 1986 * Acid-base status determines the renal expression of Ca2 and Mg2 transport proteins TNijenhuis KYRenkema JGHoenderop RJBindels J Am Soc Nephrol 17 2006 * Effects of chlorothiazide and amipramizide (MK 870) on the renal excretion of calcium, phosphate and magnesium CGDuarte Metabolism 17 1968 * Magnesium metabolism in type 2 diabetes mellitus, metabolic syndrome and insulin resistance MBarbagallo LJDominguez Arch Biochem Biophys 458 2007 * Lower serum magnesium levels are associated with more rapid decline of renal function in patients with diabetes mellitus type 2 PCPham PMPham PAPham SVPham HVPham JMMiller NYanagawa PTPham Clin Nephrol 63 2005 * Magnesium deficiency produces insulin resistance and increased thromboxane synthesis JLNadler TBuchanan RNatarajan IAntonipillai RBergman RRude Hypertension1993 21 * Hypomagnesaemia in relation to diabetic retinopathy ACeriello DGuiglano DelloRusso PPassariello N Diabetes Care 5 1980 * Study of Magnesiun, Glycosylated hemoglobin and lipid profile in diabetic retinopathy SAIshrat Kareem JSJaweed VPBardapurkar Pati Indian Journal of Clinical Biochemistry 19 2 2004 * FGuerrero-Romero MRodriguez-Moran * Hypomagnesemia, oxidative stress, inflammation, and metabolic syndrome Diabetes Metab Res Rev 22 2006 * The effect of magnesium supplementation in increasing doses on the control of type 2 diabetes MDe Lordes Lima TCruz JCPousada LERodrigues KBarbosa VCanguçu Diabetes Care 21 1998 * Lipid profile and Glycosylated haemoglobin in type 2 Diabetes Mellitus patients MohantySSupriya RMurgod VPinnelli Bk DSRaghavendra Hypomagnesemia International Journal of Chemical and Pharmaceutical Research 1 2012 Ankush RD, Suryakar AN, Ankush NR * Hypomagnesaemia in type-2 diabetes mellitus patients: a study on the status of oxidative and nitrosative stress Ind J Clin Biochem 24 2009