J Korean Med Sci.  2014 Jan;29(1):84-89. 10.3346/jkms.2014.29.1.84.

Serum Magnesium Level Is Associated with Type 2 Diabetes in Women with a History of Gestational Diabetes Mellitus: The Korea National Diabetes Program Study

• Yang SJ
• Hwang SY
• Baik SH
• Lee KW
• Nam MS
• Park YS
• Woo JT
• Kim YS
• Park S
• Park SY
• Yim CH
• Yoon HK
• Kim SH

• KMID: 1796919
• DOI: http://doi.org/10.3346/jkms.2014.29.1.84

Abstract

Gestational diabetes mellitus (GDM) is a strong predictor of postpartum prediabetes and transition to overt type 2 diabetes (T2DM). Although many reports indicate that low magnesium is correlated with deteriorated glucose tolerance, the association between postpartum serum magnesium level and the risk for T2DM in women with a history of GDM has not been evaluated. We analyzed postpartum serum magnesium levels and development of prediabetes and T2DM in women with prior GDM according to American Diabetes Association (ADA) criteria using the Korean National Diabetes Program (KNDP) GDM cohort. During a mean follow-up of 15.6+/-2.0 months after screening, 116 women were divided into three groups according to glucose tolerance status. Ultimately, eight patients (6.9%) were diagnosed with T2DM, 59 patients (50.9%) with prediabetes, and 49 patients (42.2%) with normal glucose tolerance (NGT) after follow-up. The T2DM group had the lowest serum magnesium level (0.65 [0.63-0.68] mM/L) in the postpartum period, but there was no significant difference between the prediabetes group (0.70 [0.65-0.70] mM/L) and the NGT group (0.70 [0.65-0.70] mM/L) (P=0.073) Multiple logistic regression analysis showed that postpartum HOMA-IR was a significant predictor of both prediabetes and T2DM. Moreover, we found that postpartum serum magnesium level was also a possible predictor for T2DM development. Serum magnesium level in the postpartum period may be a possible predictor for T2DM development in women with a history of GDM.

Keyword

Diabetes, Gestational; Serum Magnesium; Hypomagnesaemia; Prediabetes; Diabetes Mellitus; Type 2

MeSH Terms

Adult
Blood Glucose
Cohort Studies
Diabetes Mellitus, Type 2/*blood/diagnosis
Diabetes, Gestational/*blood
Female
Glucose Intolerance/*blood
Glucose Tolerance Test
Humans
Insulin Resistance
Magnesium/*blood
Postpartum Period/*blood
Prediabetic State/diagnosis
Pregnancy
Prospective Studies
Republic of Korea
Risk Factors
Blood Glucose
Magnesium

Figure

• 

  Fig. 1 Postpartum serum magnesium level according to glucose tolerance statusduring the follow-up period (NGT, normal glucose tolerance; T2DM, type 2 diabetes mellitus).

Reference

1. Ratner RE, Christophi CA, Metzger BE, Dabelea D, Bennett PH, Pi-Sunyer X, Fowler S, Kahn SE. Diabetes Prevention Program Research Group. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab. 2008; 93:4774–4779.

2. Kim DJ, Xun P, Liu K, Loria C, Yokota K, Jacobs DR Jr, He K. Magnesium intake in relation to systemic inflammation, insulin resistance, and the incidence of diabetes. Diabetes Care. 2010; 33:2604–2610.

3. Song Y, Li TY, van Dam RM, Manson JE, Hu FB. Magnesium intake and plasma concentrations of markers of systemic inflammation and endothelial dysfunction in women. Am J Clin Nutr. 2007; 85:1068–1074.

4. He K, Liu K, Daviglus ML, Morris SJ, Loria CM, Van Horn L, Jacobs DR Jr, Savage PJ. Magnesium intake and incidence of metabolic syndrome among young adults. Circulation. 2006; 113:1675–1682.

5. Jaipakdee S, Prasongwatana V, Premgamone A, Reungjui S, Tosukhowong P, Tungsanga K, Suwantrai S, Noppawinyoowong C, Maskasame S, Sriboonlue P. The effects of potassium and magnesium supplementations on urinary risk factors of renal stone patients. J Med Assoc Thai. 2004; 87:255–263.

6. Kao WH, Folsom AR, Nieto FJ, Mo JP, Watson RL, Brancati FL. Serum and dietary magnesium and the risk for type 2 diabetes mellitus: the Atherosclerosis Risk in Communities Study. Arch Intern Med. 1999; 159:2151–2159.

7. Lopez-Ridaura R, Willett WC, Rimm EB, Liu S, Stampfer MJ, Manson JE, Hu FB. Magnesium intake and risk of type 2 diabetes in men and women. Diabetes Care. 2004; 27:134–140.

8. Guerrero-Romero F, Rascón-Pacheco RA, Rodríguez-Morán M, de la Peña JE, Wacher N. Hypomagnesaemia and risk for metabolic glucose disorders: a 10-year follow-up study. Eur J Clin Invest. 2008; 38:389–396.

9. Song Y, Manson JE, Buring JE, Liu S. Dietary magnesium intake in relation to plasma insulin levels and risk of type 2 diabetes in women. Diabetes Care. 2004; 27:59–65.

10. Lecube A, Baena-Fustegueras JA, Fort JM, Pelegrí D, Hernández C, Simó R. Diabetes is the main factor accounting for hypomagnesemia in obese subjects. PLoS One. 2012; 7:e30599.

11. Rodríguez-Morán M, Guerrero-Romero F. Oral magnesium supplementation improves insulin sensitivity and metabolic control in type 2 diabetic subjects: a randomized double-blind controlled trial. Diabetes Care. 2003; 26:1147–1152.

12. Eibl NL, Kopp HP, Nowak HR, Schnack CJ, Hopmeier PG, Schernthaner G. Hypomagnesemia in type II diabetes: effect of a 3-month replacement therapy. Diabetes Care. 1995; 18:188–192.

13. Paolisso G, Sgambato S, Gambardella A, Pizza G, Tesauro P, Varricchio M, D'Onofrio F. Daily magnesium supplements improve glucose handling in elderly subjects. Am J Clin Nutr. 1992; 55:1161–1167.

14. Rhee SY, Chon S, Kwon MK, Park IeB, Ahn KJ, Kim IJ, Kim SH, Lee HW, Koh KS, Kim DM, et al. Prevalence of chronic complications in Korean patients with type 2 diabetes mellitus based on the Korean national diabetes program. Diabetes Metab J. 2011; 35:504–512.

15. American Diabetes Association. Standards of medical care in diabetes: 2011. Diabetes Care. 2011; 34:S11–S61.

16. Paolisso G, Scheen A, D'Onofrio F, Lefèbvre P. Magnesium and glucose homeostasis. Diabetologia. 1990; 33:511–514.

17. Takaya J, Higashino H, Kobayashi Y. Intracellular magnesium and insulin resistance. Magnes Res. 2004; 17:126–136.

18. Song CH, Song IK, Ju SY, Ock SM. Serum magnesium level is negatively associated with fasting serum glucose level in Korean adults. Biol Trace Elem Res. 2011; 143:612–618.

19. Chaudhary DP, Sharma R, Bansal DD. Implications of magnesium deficiency in type 2 diabetes: a review. Biol Trace Elem Res. 2010; 134:119–129.

20. Weinert LS. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy: comment to the International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Diabetes Care. 2010; 33:e97.

21. Sales CH, Pedrosa LF, Lima JG, Lemos TM, Colli C. Influence of magnesium status and magnesium intake on the blood glucose control in patients with type 2 diabetes. Clin Nutr. 2011; 30:359–364.

22. Shils ME. Experimental human magnesium depletion. Medicine (Baltimore). 1969; 48:61–85.

23. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008; 358:1991–2002.

24. Pham PC, Pham PM, Pham PA, Pham SV, Pham HV, Miller JM, Yanagawa N, Pham PT. Lower serum magnesium levels are associated with more rapid decline of renal function in patients with diabetes mellitus type 2. Clin Nephrol. 2005; 63:429–436.

25. Håglin L, Törnkvist B, Bäckman L. Prediction of all-cause mortality in a patient population with hypertension and type 2 DM by using traditional risk factors and serum-phosphate,-calcium and-magnesium. Acta Diabetol. 2007; 44:138–143.

26. Dunn MJ, Walser M. Magnesium depletion in normal man. Metabolism. 1966; 15:884–895.

27. Alfrey AC, Miller NL, Butkus D. Evaluation of body magnesium stores. J Lab Clin Med. 1974; 84:153–162.

28. Pham PC, Pham PM, Pham SV, Miller JM, Pham PT. Hypomagnesemia in patients with type 2 diabetes. Clin J Am Soc Nephrol. 2007; 2:366–373.

29. Mooren FC, Krüger K, Völker K, Golf SW, Wadepuhl M, Kraus A. Oral magnesium supplementation reduces insulin resistance in non-diabetic subjects - a double-blind, placebo-controlled, randomized trial. Diabetes Obes Metab. 2011; 13:281–284.

30. Kisters K. Oral magnesium supplementation improves borderline hypertension. Magnes Res. 2011; 24:17.

31. Takaya J, Yamato F, Kaneko K. Possible relationship between low birth weight and magnesium status: from the standpoint of "fetal origin" hypothesis. Magnes Res. 2006; 19:63–69.