Magnesium and insulin-dependent diabetes mellitus

Prevalence of Dysmagnesemia among Patients with Diabetes Mellitus and the Associated Health Outcomes: A Cross-Sectional Study

Introduction: Magnesium is a vital intracellular cation crucial for over 320 enzymatic reactions related to energy metabolism, musculoskeletal function, and nucleic acid synthesis and plays a pivotal role in human physiology. This study aimed to explore the prevalence of dysmagnesemia in patients with diabetes mellitus and evaluate its correlations with glycemic control, medication use, and diabetic complications. Methods: A cross-sectional study was conducted at Sultan Qaboos University Hospital, including 316 patients aged 18 years or older with diabetes mellitus. Data included demographics, medical history, medications, and biochemical parameters. Serum total magnesium concentrations were measured, and dysmagnesemia was defined as magnesium ≤ 0.69 mmol/L for hypomagnesemia and ≥1.01 mmol/L for hypermagnesemia. Results: The prevalence of hypomagnesemia in patients with diabetes was 17.1% (95% CI: 13.3-21.7%), and hypermagnesemia was 4.1% (95% CI: 2.4-7.0%). Females were significantly overrepresented in the hypomagnesemia group, while the hypermagnesemia group showed a higher prevalence of hypertension, retinopathy, an increased albumin/creatinine ratio, chronic kidney disease (CKD), elevated creatinine levels, and a lower adjusted calcium concentration. The multinominal logistic regression exhibited that the female sex and higher serum-adjusted calcium were independent risk factors of hypomagnesemia. In contrast, the presence of hypertension, higher levels of albumin/creatinine ratio, and stage 5 CKD were independent risk factors of hypermagnesemia. Conclusions: Hypomagnesemia was common among patients with diabetes mellitus; however, hypermagnesemia was associated with microvascular complications.

Investigation of the Effects of L-carnitine and magnesium on Oxidative Stress and Cytokines in the Tissue of Experimental diabetic rats

The aim of this study was to determine the effects of L-carnitine and magnesium on the levels of tissue malondialdehyde, 8-hydroxy-2’-deoxyguanosine, and cytokines (tumor necrosis factor alpha, interleukin-6) in streptozotocin-induced experimental diabetes in rats. Eighty male Wistar albino rats (200-250 g) were divided into 8 groups with 10 rats in each group. The groups received the following treatments: Control group; 2 ml distilled water (by gavage); Group 2: 50 mg/kg (b.w.) i.p. streptozotocin; Group 3: 125 mg/kg (b.w.) magnesium; Group 4: 300 mg/kg (b.w.) L-carnitine; Group 5: 125 mg/kg (b.w.) magnesium +300 mg/kg (b.w.) L-carnitine; Group 6: 50 mg/kg (b.w.) streptozotocin +125 mg/kg (b.w.) magnesium; Group 7: 50 mg/kg (b.w.) streptozotocin +300 mg/kg (b.w.) L-carnitine and Group 8: 50 mg/kg (b.w.) streptozotocin +125 mg/ kg (b.w.) magnesium+300 mg/kg (b.w.) L-carnitine administered for 4 weeks. Liver and kidney malondialdehyde, 8-hydroxy-2’-deoxyguanosine, tumor necrosis factor alpha and interleukin-6 levels did not change in the magnesium, L-carnitine, and magnesium + L-carnitine groups compared to the control. The highest levels of malondialdehyde, 8-hydroxy-2’-deoxyguanosine, tumor necrosis factor alpha and interleukin-6 were determined only in the group with diabetes (Group 2). Lipid peroxidation, DNA damage, and cytokine levels were significantly reduced in diabetic animals with the administration of magnesium and L-carnitine separately or in combination. Based on the obtained results it can be concluded that magnesium and L-carnitine may have antidiabetic effects, especially in combination.

Association between Vitamin D Receptor Polymorphisms (BsmI and FokI) and Glycemic Control among Patients with Type 2 Diabetes

(1) Background: Several studies have suggested that the vitamin D receptor (VDR) gene plays a role in type 2 diabetes mellitus (T2DM) susceptibility. Nonetheless, the association between T2DM and VDR polymorphisms remains inconclusive. We determined the genotype of VDR rs1544410 (BsmI) and rs2228570 (FokI) polymorphisms among Malaysian patients with T2DM and their association with glycemic control factors (vitamin D levels, calcium, magnesium, and phosphate). (2) Methods: A total of 189 participants comprising 126 patients with T2DM (63 with good glycemic control and 63 with poor glycemic control) and 63 healthy controls were enrolled in this case-control study. All biochemical assays were measured using spectrophotometric analysis. VDR gene FokI and BsmI polymorphisms were analyzed using polymerase chain reaction and endonuclease digestion. (3) Results: Our findings revealed no significant differences in VDR FokI and BsmI genotypes between participants with T2DM and healthy controls. Moreover, no significant association was observed between both single nucleotide polymorphisms and glycemic control factors. Participants with poor glycemic control had significantly lower serum magnesium levels and significantly higher HOMA-IR compared to the other groups. (4) Conclusions: The present study revealed that VDR gene BsmI and FokI polymorphisms were not significantly associated with T2DM.

Bone Health Index and bone turnover in pediatric patients with type 1 diabetes mellitus and poor metabolic control

BACKGROUND

There is a need for a non-invasive, affordable, and reliable method for bone health screening in pediatric patients at risk.

OBJECTIVE

To assess Bone Health Index (BHI) in pediatric patients with type 1 diabetes (T1D) and its relation to bone metabolism, age at onset, duration, control, and insulin dose.

SUBJECTS AND METHODS

Left-hand radiographs were obtained from 65 patients with T1D, mean age 11.23 ± 3.89 years, mean disease duration 5.23 ± 3.76 years and mean glycosylated hemoglobin (HbA1c)-83 mmol/mol (9.7%). Blood and 24 hours urine samples were collected for bone and mineral metabolism assessment. BoneXpert was used to determine BHI, Bone Health Index standard deviation score (BHI SDS), and bone age.

RESULTS

Mean BHI SDS was -1.15 ± 1.19 (n = 54). In 20.37% (n = 11) BHI SDS was < -2SD with mean value -2.82 ± 0. 69, P < .001. These patients had lower levels of beta cross laps (0.77  ± 0.33 ng/mL vs 1.17 ± 0.47 ng/mL), osteocalcin (47.20 ± 14.07 ng/mL vs 75.91 ± 32.08 ng/mL), serum magnesium (0.79 ± 0.05 mmol/L vs 0.83 ± 0.06 mmol/L) and phosphorus (1.48 ± 0.29 mmol/L vs 1.71 ± 0.28 mmol/L) but higher ionized calcium (1.29 ± 0.04 mmol/L vs 1.26 ± 0.05 mmol/L), P < .05, compared to patients with BHI SDS in the normal range. We found a positive correlation between BHI SDS and age at manifestation (r = 0.307, P = 0.024) and a negative one with disease duration (r = -0.284, P = .038). No correlations were found with HbA1c, insulin dose, height, weight, BMI.

CONCLUSIONS

To the best of our knowledge, this is the first study to assess bone health in pediatric patients with T1D using BHI. We found significantly decreased cortical bone density and bone turnover in 20.37%. Earlier age at onset and diabetes duration may have a negative impact on cortical bone density in patients with poor control. Longitudinal studies are needed to follow changes or to assess future interventions.

Oral Supplementation Effect of Iron and its Complex Form With Quercetin on Oxidant Status and on Redistribution of Essential Metals in Organs of Streptozotocin Diabetic Rats

Background and aims: Quercetin, is a polyphenolic antioxidant compound. It is able to form complex with metal ions such as iron and exerts a broad range of biological activities like improving metabolic disorders. This research aims at investigating the effect of oral supplementation of iron (2.5mg Fe/Kg/day) and its complex form (molar ratio 1:5; 2.5mg/25mg/Kg/day) with quercetin (25mg/Kg/day) on lipid metabolism, oxidant status and trace elements contents in organs of Wistar diabetic rats (45 mg/kg/rat.ip of streptozotocin) during eight weeks of experimentation.

Material and method: To achieve this, liver and adipose tissue enzymes activities, NO • , O2 −• , TBARs, carbonyl protein levels in plasma were analysed. Metals (Cu, Fe, Mg, Zn) analysis of organs were determined by inductively coupled plasma atomic emission spectroscopy.

Results: Iron supplemented alone induced a noticeable disorder in lipid, lipoprotein, lipases and oxidant status. Yet, it caused an imbalance in the redistribution of metals in the organs of diabetic and non diabetic rats. Iron-quercetin complex was shown as less harmful and more beneficial than iron supplemented alone.

Conclusions: This complex could reverse oxidative stress and iron deficiency mostly caused by the diabetic disease but at the same time it induces an imbalance in redistribution of other essential metals.

TRPM channels as potential therapeutic targets against pro-inflammatory diseases

The immune system protects our body against foreign pathogens. However, if it overshoots or turns against itself, pro-inflammatory diseases, such as rheumatoid arthritis, inflammatory bowel disease, or diabetes develop. Ions, the most basic signaling molecules, shape intracellular signaling cascades resulting in immune cell activation and subsequent immune responses. Mutations in ion channels required for calcium signaling result in human immunodeficiencies and highlight those ion channels as valued targets for therapies against pro-inflammatory diseases. Signaling pathways regulated by melastatin-like transient receptor potential (TRPM) cation channels also play crucial roles in calcium signaling and leukocyte physiology, affecting phagocytosis, degranulation, chemokine and cytokine expression, chemotaxis and invasion, as well as lymphocyte development and proliferation. Therefore, this review discusses their regulation, possible interactions and whether they can be exploited as targets for therapeutic approaches to pro-inflammatory diseases.

Hypomagnesemia and inflammation: clinical and basic aspects

In recent years, increasing awareness of hypomagnesemia has resulted in clinical trials that associate this mineral deficiency with diabetes, metabolic syndrome, and drug therapies for cancer and cardiovascular diseases. However, diagnostic testing for tissue deficiency of magnesium still presents a challenge. Investigations of animal and cellular responses to magnesium deficiency have found evidence of complex proinflammatory pathways that may lead to greater understanding of mediators of the pathobiology in neuronal, cardiovascular, intestinal, renal, and hematological tissues. The roles of free radicals, cytokines, neuropeptides, endotoxin, endogenous antioxidants, and vascular permeability, and interventions to limit the inflammatory response associated with these parameters, are outlined in basic studies of magnesium deficiency. It is hoped that this limited review of inflammation associated with some diseases complicated by magnesium deficiency will prompt greater awareness by clinicians and other health providers and in turn increase efforts to prevent and treat this disorder.

Arginase activity and magnesium levels in blood of children with diabetes mellitus

Under physiological conditions insulin controls the metabolism of carbohydrates, lipids and proteins. Diabetes mellitus is a metabolic disease characterized by a disturbance in the intermediary metabolism of glucose and glucose-induced insulin release. Arginase (L-arginine amidinohydrolase, EC 3.5.3.1) modulates nitric oxide synthase activity by regulating intracellular L-arginine availability. In diabetes mellitus, a decrease in nitric oxide bioavailability is a central mechanism for endothelial dysfunction. The aim of our study was to assess arginase activity in the blood of children with diabetes mellitus. Blood arginase activity, serum glucose (14.155 +/- 4.197 mmol/L; p < .001) and blood HbA1c (11.222 +/- 3.186 %; p < .001), were significantly higher in diabetic children than in healthy controls, whereas the magnesium (Mg2+) level, a cofactor of many enzymes, was significantly lower (0.681 +/- 0.104 micromol; p < .001). In diabetic children, arginase activity, hyperglycemia (r = 0.143), and the HbA1, level (r = 0.381) showed a positive correlation between but a negative correlation between Mg2+ and arginase activity (r= -0.206). The higher arginase activity and the lower Mg2+' levels in diabetic children could be a consequence of reduced insulin action and increased protein catabolic processes in these pathophysiological conditions. The inverse directions of arginase activity and serum Mg2+ levels are in agreement with this concept.

Zinc in a combination with magnesium helps reducing negative effects of heat stress in quails

The objective of this study was to investigate whether zinc (Zn) along with magnesium (Mg) is effective in alleviating the negative effects of heat stress in Japanese quails. One hundred and twenty 10-day-old healthy Japanese quails were randomly assigned to four treatment groups, three replicates of ten birds each. The birds were fed either a basal diet or the basal diet supplemented with either 30 mg of Zn/kg of diet, 600 mg of Mg/kg of diet, or 30 mg of Zn + 600 mg of Mg/kg of diet. The birds were kept under a high temperature (35 degrees C) for 8 h/day. Feed consumption was greatest with the combination of Zn and Mg supplementation (P < 0.01). Hot and chilled dressing percentages were greater (P < 0.05) with Zn- and Mg-supplemented diets. Concentrations of plasma malondialdehyde were lower (P < 0.01) with both Zn and Mg supplementations. Mg concentrations in the serum remained similar with either Zn or Mg supplements in the diet (P > 0.05). Serum glucose concentrations were lowest in birds fed the basal diet. Supplementing a combination of Zn and Mg may offer a potential protective management practice in preventing heat stress-related depression in performance of quails.

Hypomagnesemia in patients with type 2 diabetes

Hypomagnesemia has been reported to occur at an increased frequency among patients with type 2 diabetes compared with their counterparts without diabetes. Despite numerous reports linking hypomagnesemia to chronic diabetic complications, attention to this issue is poor among clinicians. This article reviews the literature on the metabolism of magnesium, incidence of hypomagnesemia in patients with type 2 diabetes, implicated contributing factors, and associated complications. Hypomagnesemia occurs at an incidence of 13.5 to 47.7% among patients with type 2 diabetes. Poor dietary intake, autonomic dysfunction, altered insulin metabolism, glomerular hyperfiltration, osmotic diuresis, recurrent metabolic acidosis, hypophosphatemia, and hypokalemia may be contributory. Hypomagnesemia has been linked to poor glycemic control, coronary artery diseases, hypertension, diabetic retinopathy, nephropathy, neuropathy, and foot ulcerations. The increased incidence of hypomagnesemia among patients with type 2 diabetes presumably is multifactorial. Because current data suggest adverse outcomes in association with hypomagnesemia, it is prudent to monitor magnesium routinely in this patient population and treat the condition whenever possible.

Oral magnesium administration prevents thermal hyperalgesia induced by diabetes in rats

BACKGROUND

Peripheral neuropathy is a common complication of diabetes mellitus. It has been shown that hyperglycemia may contribute to its development but the exact pathophysiology underlying this complication is not fully understood. Since oral magnesium supplementation can normalize hyperglycemia induced by diabetes in rats, this study was designed to examine the effect of oral magnesium administration on thermal hyperalgesia in streptozocin-induced diabetic rats.

MATERIAL AND METHODS

Twenty-four male adult wistar rats were divided equally into control, magnesium-treated control, diabetic and magnesium-treated diabetic groups. In magnesium-treated diabetic rats, magnesium sulfate (10g/l) was added into the drinking water once diabetes was established (10 days after STZ injection) and continued for 8 weeks. Mg-treated control animals received magnesium sulfate in the same dose and over the same time period. The other two groups; control and diabetic animals, only received tap water. At the end of the 8 weeks, thermal pain threshold was assessed by tail flick test and magnesium and glucose plasma levels were measured in all groups.

RESULT

A significant decrease (p<0.001) in thermal pain threshold and plasma magnesium levels and an increase in plasma glucose levels (p<0.001) were seen in diabetic rats 8 weeks after diabetes induction. After 8 weeks of oral magnesium, thermal hyperalgesia was normalized and plasma magnesium and glucose levels were restored towards normal.

CONCLUSION

It is concluded that oral magnesium administration given at the time of diabetes induction may be able to restore thermal hyperalgesia, magnesium deficiency and hyperglycemia and in diabetic rats.

The Role of Antioxidant Micronutrients in the Prevention of Diabetic Complications

Diabetes mellitus is associated with an increased production of reactive oxygen species and a reduction in antioxidant defenses. This leads to oxidative stress, which is partly responsible for diabetic complications. Tight glycemic control is the most effective way of preventing or decreasing these complications. Nevertheless, antioxidant micronutrients can be proposed as adjunctive therapy in patients with diabetes. Indeed, some minerals and vitamins are able to indirectly participate in the reduction of oxidative stress in diabetic patients by improving glycemic control and/or are able to exert antioxidant activity. This article reviews the use of minerals (vanadium, chromium, magnesium, zinc, selenium, copper) and vitamins or cofactors (tocopherol [vitamin E], ascorbic acid [vitamin C], ubidecarenone [ubiquinone; coenzyme Q], nicotinamide, riboflavin, thioctic acid [lipoic acid], flavonoids) in diabetes, with a particular focus on the prevention of diabetic complications. Results show that dietary supplementation with micronutrients may be a complement to classical therapies for preventing and treating diabetic complications. Supplementation is expected to be more effective when a deficiency in these micronutrients exists. Nevertheless, many clinical studies have reported beneficial effects in individuals without deficiencies, although several of these studies were short term and had small sample sizes. However, a randomized, double-blind, placebo-controlled, multicenter trial showed that thioctic acid at an oral dosage of 800 mg/day for 4 months significantly improved cardiac autonomic neuropathy in type 2 diabetic patients. Above all, individuals with diabetes should be educated about the importance of consuming adequate amounts of vitamins and minerals from natural food sources, within the constraints of recommended sugar and carbohydrate intake.

Drinking water composition and childhood-onset Type 1 diabetes mellitus in Devon and Cornwall, England

AIMS

Previous studies have reported inconsistent results on the association between some compositions (e.g. nitrate) in domestic water and the risk of childhood-onset Type 1 diabetes mellitus. This study aimed to examine the relationship between nitrate, zinc and magnesium in drinking water and the risk of childhood-onset Type 1 diabetes mellitus.

METHODS

The study covers the Cornwall and the former Plymouth Health Authority Regions in the far south-west of England. Five hundred and seventeen children, aged 0-15 years, diagnosed with Type 1 diabetes mellitus between 1975 and 1996, were identified for inclusion in the study. Domestic water data (nitrate, Zn, Mg, Cu, Al, Ca, Fe and Mn) between 1993 and 1997 were provided by South-west Water Plc, UK, for each of the 40 Water Supply Zones in which the subjects had been resident at the time of diagnosis. The standardized incidence ratio (SIR) of the disease was calculated for each Water Supply Zone using the UK 1991 census population data. The relationship between the SIR of the disease and the water quality indicators in thirds (three strata of low, medium and high concentrations) was examined by chi2 test for trend and Poisson regression analysis.

RESULTS

The initial analyses by chi2 test for trend on the relation of SIRs and drinking water compositions suggested that copper, magnesium and nitrate might have some protective effects, but Poisson regression analyses showed that only zinc and magnesium were significant factors. The data suggest that the incidence rate of childhood diabetes is significantly lower when the concentrations of zinc and magnesium in the domestic drinking water are in the range 22.27-27.00 microg/l (incidence rate ratio (IRR), 0.76; 95% CI, 0.59-0.97) and greater than 2.61 mg/l (IRR, 0.72; 95% CI, 0.58-0.91), respectively.

CONCLUSIONS

Our findings suggest evidence of a possible association between zinc and magnesium in the domestic drinking water and childhood diabetes in the far south-west of England. However, these possible protective effects of zinc and magnesium in domestic drinking water warrant further confirmation.

Exploiting complementary therapeutic strategies for the treatment of type II diabetes and prevention of its complications

Impaired glycemic control in type II diabetes results from peripheral insulin resistance, hepatic insulin resistance, and a relative failure of beta cell function. Nutritional and pharmaceutical measures are now available for addressing each of these defects, presumably enabling a rational and highly effective clinical management of non-insulin-dependent diabetes mellitus. Peripheral insulin resistance, which usually responds to a very-low-fat diet, aerobic exercise training, and appropriate weight loss, can also treated with high-dose chromium picolinate, high-dose vitamin E, magnesium, soluble fiber, and possibly taurine; these measures appear likely to correct the diabetes-associated metabolic derangements of vascular smooth muscle, and thus lessen risk for macrovascular disease. Metformin's clinical efficacy is primarily reflective of reduced hepatic glucose output; this action should complement the benefits of peripheral insulin sensitizers. When these measures are not sufficient for optimal control, beta cell function can be boosted with second-generation sulfonylureas.

Serum magnesium and protein concentrations during the first five years of insulin-dependent diabetes in children

Thirty-four children were followed up prospectively for 5 years from the onset of diabetes regarding serum magnesium, zinc and some proteins. Serum magnesium decreased to significantly lower values (0.76 +/- 0.05 mmol l-1) than those in matched controls after 2 and 5 years, with the lowest mean values in diabetic girls. Serum zinc concentration was higher in the diabetic group than in the control children, and again the diabetic girls differed most from the controls. Serum prealbumin was significantly lower in the diabetic patients after 2 and 5 years than in the controls. Serum albumin was also slightly reduced in the diabetic patients, while orosomucoid was normal. These data indicate chronic magnesium deficiency and insufficient liver synthesis of certain serum proteins in diabetic children.

Up-regulation of intracellular signalling pathways may play a central pathogenic role in hypertension, atherogenesis, insulin resistance, and cancer promotion--the 'PKC syndrome'

The modern diet is greatly different from that of our paleolithic forebears' in a number of respects. There is reason to believe that many of these dietary shifts can up-regulate intracellular signalling pathways mediated by free intracellular calcium and protein kinase C, particularly in vascular smooth muscle cells; this disorder of intracellular regulation is given the name 'PKC syndrome'. PKC syndrome may entail either a constitutive activation of these pathways, or a sensitization to activation by various agonists. The modern dietary perturbations which tend to induce PKC syndrome may include increased dietary fat and sodium, and decreased intakes of omega-3 fats, potassium, calcium, magnesium and chromium. Insulin resistance may be both a cause and effect of PKC syndrome, and weight reduction and aerobic training should act to combat this disorder. PKC syndrome sensitizes vascular smooth muscle cells to both vasoconstrictors and growth factors, and thus promotes both hypertension and atherogenesis. In platelets, it induces hyperaggregability, while in the microvasculature it may be a mediator of diabetic microangiopathy. In vascular endothelium, intimal macrophages, and hepatocytes, increased protein kinase C activity can be expected to increase cardiovascular risk. Up-regulation of protein kinase C in stem cells may also play a role in the promotion of 'Western' fat-related cancers. Practical guidelines for combatting PKC syndrome are suggested.

Complementary vascular-protective actions of magnesium and taurine: a rationale for magnesium taurate

By a variety of mechanisms, magnesium functions both intracellularly and extracellularly to minimize the cytoplasmic free calcium level, [Ca2+]i. This may be the chief reason why correction of magnesium deficiency, or induction of hypermagnesemia by parenteral infusion, exerts antihypertensive, anti-atherosclerotic, anti-arrhythmic and antithrombotic effects. Although the amino acid taurine can increase systolic calcium transients in cardiac cells (and thus has positive inotropic activity), it has other actions which tend to reduce [Ca2+]i. Indeed, in animal or clinical studies, taurine lowers elevated blood pressure, retards cholesterol-induced atherogenesis, prevents arrhythmias and stabilizes platelets--effects parallel to those of magnesium. The complex magnesium taurate may thus have considerable potential as a vascular-protective nutritional supplement, and might also be administered parenterally, as an alternative to magnesium sulfate, in the treatment of acute myocardial infarction as well as of pre-eclampsia. The effects of magnesium taurate in diabetes deserve particular attention, since both magnesium and taurine may improve insulin sensitivity, and also may lessen risk for the micro- and macrovascular complications of diabetes.

The important role of modifiable dietary and behavioral characteristics in the causation and prevention of coronary heart disease hospitalization and mortality: the prospective NHANES I follow-up study

OBJECTIVE

Our specific aim in the prospective, longitudinal assessment of 8,251 subjects in the National Health and Nutrition Examination Survey, NHANES I, followup study was to assess the important roles of modifiable dietary and behavioral characteristics in the causation and prevention of coronary heart disease (CHD).

METHODS

Using NHANES I prospective 10 year followup data, we studied 8,251 subjects; 492 with cardiovascular events and 7,759 without events during the followup period (1971-75 to 1982-84). Using general linear models and logistic regression, we assessed the relationships of CHD risk factors to CHD morbidity and mortality.

RESULTS

By logistic regression, the following factors were independently, significantly, and inversely associated with coronary heart and vascular disease deaths and hospitalizations: alcohol intake, dietary riboflavin, dietary iron, serum magnesium, leisure time exercise, habitual physical activity, and female gender. Positive significant independent determinants of CHD events included cigarette smoking, sedimentation rate, Quetelet index, maximum body weight, and age.

CONCLUSIONS

These associations emphasize the important role of modifiable dietary and behavioral characteristics in the causation and prevention of CHD.

Magnesium deficiency in alcoholism: possible contribution to osteoporosis and cardiovascular disease in alcoholics

Magnesium (Mg) deficiency occurs frequently in chronic alcoholism and may contribute to the increased incidence of osteoporosis and cardiovascular disease seen in this population. Mg deficiency is primarily due to renal Mg-wasting and is exacerbated by dietary Mg deprivation, gastrointestinal losses with diarrhea or vomiting, as well as concomitant use of drugs such as diuretics and aminoglycosides. Osteoporosis is prevalent in the alcoholic population. Mg deficiency may contribute to increased bone loss by its effects on mineral homeostasis. In Mg depletion, there is often hypocalcemia due to impaired parathyroid hormone (PTH) secretion, as well as renal and skeletal resistance to PTH action. Serum concentrations of 1,25-vitamin D are also low. These changes are seen with even mild degrees of Mg deficiency and may contribute to the metabolic bone disease seen in chronic alcoholics. Hypomagnesemia in alcoholics may also contribute to increased cardiovascular disease by altering platelet function. Mg deficiency has been demonstrated to enhance platelet reactivity. In these studies, Mg was shown to inhibit platelet aggregation against various aggregation agents. Patients with Mg deficiency were shown to have increased platelet aggregation that was normalized with Mg therapy. The antiplatelet effect of Mg may be related to the finding that Mg inhibits the synthesis of thromboxane A2 and 12-hydroxyeicosatetraenoic acid, eicosanoids thought to be involved in platelet aggregation. Mg also inhibits the thrombin-induced Ca2+ influx in platelets, as well as stimulates synthesis of prostaglandin I2, the potent antiaggregatory eicosanoid. Therefore, Mg deficiency may increase platelet aggregation and cause increased hypertension and atherosclerotic cardiovascular disease in alcoholics.

Information on type 1 diabetes mellitus and QT interval from identical twins

To determine whether QT interval is influenced by genetic factors and whether QT-interval prolongation occurs in type 1 diabetes or is related to diabetic autonomic neuropathy, QT intervals were measured, and autonomic function was assessed in 44 pairs of identical twins who were discordant for type 1 diabetes. Twins were compared with 44 normal control subjects of similar age and sex. QT intervals were corrected for heart rate (QTc). QTc in diabetic twins correlated with that in their nondiabetic co-twins (r = 0.41; p = 0.006). Diabetic twins had significantly longer QTc than did their nondiabetic co-twins and control subjects (416 +/- 18 vs 407 +/- 16 and 403 +/- 19 ms, respectively; p < 0.005). A greater number of abnormal autonomic function tests were detected in diabetic twins than in their nondiabetic co-twins and control subjects (8 vs 2 and 0%, respectively; p < 0.01). Diabetic twins with disease duration > 14 years (n = 22) had longer QTc than did their nondiabetic co-twins (420 +/- 17 vs 402 +/- 14 ms; p < 0.0005). Twins with diabetes for > 14 years had a greater frequency of abnormal autonomic function tests than did those with diabetes < 14 years (15 vs 2%; p < 0.001). QTc did not correlate with autonomic function in diabetic twins. It is concluded that QT interval is influenced by genetic factors, and in type 1 diabetes, QTc can be prolonged independently of autonomic neuropathy.

Vitamin and mineral supplementation in patients with diabetes mellitus

Most patients with diabetes generally do not require routine vitamin and mineral supplementation, just like the rest of the population. However, based on the published medical literature, it would appear that some degree of supplementation with certain vitamins (eg, vitamins C and E) and minerals (eg, magnesium) may be worthwhile and become more commonly recommended in the future. The role of vitamins and minerals in controlling blood glucose levels in the patients with diabetes also is discussed.