Diabetologie und Stoffwechsel 2014; 9(2): 96-100
DOI: 10.1055/s-0034-1366398
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Die Bedeutung von Magnesium für Insulinresistenz, metabolisches Syndrom und Diabetes mellitus – Empfehlungen der Gesellschaft für Magnesium-Forschung e. V.

The Significance of Magnesium in Insulin Resistance, Metabolic Syndrome and Diabetes – Recommendations of the Association of Magnesium Research e. V.
B. von Ehrlich
1   Facharzt für Innere Medizin, Kempten
,
M. Barbagallo
2   Institute for Internal Medicine and Geriatrics, University of Palermo, Palermo, Italien
,
H. G. Classen
3   ehemals Universität Stuttgart-Hohenheim, Stuttgart
,
F. Guerrero-Romero
4   Biomedical Research Unit, Mexican Social Security Institute, Durango, Mexico
,
F. C. Mooren
5   Institut für Sportwissenschaften, Abteilung für Sportmedizin, Justus-Liebig-Universität Gießen, Gießen
,
M. Rodriguez-Moran
4   Biomedical Research Unit, Mexican Social Security Institute, Durango, Mexico
,
W. Vierling
6   Institut für Pharmakologie und Toxikologie, TU München, München
,
J. Vormann
7   Institut für Prävention und Ernährung, Ismaning
,
K. Kisters
8   Medizinische Klinik I, St. Anna Hospital, Herne, Präsident der Gesellschaft für Magnesium-Forschung e. V.
› Author Affiliations
Further Information

Publication History

Publication Date:
06 May 2014 (online)

Zusammenfassung

Mangel an Magnesium (Mg) ist ein wichtiges und häufiges Begleitphänomen bei Patienten mit Diabetes mellitus oder Vorstufen eines Diabetes Typ 2 wie dem Metabolischen Syndrom. Mg-Mangel erhöht das Risiko, einen Diabetes Typ 2 zu entwickeln. Diese Empfehlungen resümieren die gegenwärtigen Kenntnisse zur Physiologie des Mg im Kohlenhydratstoffwechsel und die pathophysiologischen Folgen des Mg-Mangels bei Diabetikern. Diabetiker und Patienten mit dessen Vorstufen profitieren von vier Kategorien der Mg-Wirkmechanismen: Insulin-sensitizing-Effekt, Ca-Antagonismus, Stress-Regulation und Endothel-stabilisierender Effekt. Klinische Studiendaten mit Mg-Comedikation zeigen verminderte Insulinresistenz/verbesserte Glukose-Kontrolle und verminderte vaskuläre Langzeitschäden anhand von Surrogat-Parametern: Hohes Serum-Mg ist assoziiert mit geringerer Retinopathie-Prävalenz; der Schweregrad der Retinopathie korreliert mit dem Mg-Mangel. Hohes Serum-Mg ist auch mit einem verminderten Risiko des Nierenfunktionsverlusts verknüpft. Depression, eine häufige Diabetes-Comorbidität, ist seltener bei hohem Serum-Mg. Es wird ein standardisiertes Konzept zur Diagnose des Mg-Mangels und ein Therapieregime zur Supplementation dieser Patienten vorgelegt. Die Diagnose des Mg-Mangels ist einfach durch Synopsis von Anamnese, Klinik oder/und Laborbefund zu stellen.

Abstract

Magnesium (Mg) depletion is an important and high prevalent condition in patients with diabetes and precursor states of diabetes 2 like metabolic syndrome. Mg deficiency increases the risk of developing diabetes 2. These recommendations compile present data on the physiology of Mg in carbohydrate metabolism and pathopysiological consequences of Magnesium depletion for diabetics. Diabetes patients and candidates benefit from four categories of Mg-effects: insulin sensitizing effect, Ca antagonism, stress regulating and endothelium stabilizing effects. Clinical data with Mg comedication show improvement of insulin-resistance/blood glucose level and reduced long term vascular damages in surrogate parameters. High serum Mg is associated with lower prevalence of retinopathy, severity of retinopathy is associated with the degree of Mg depletion. High serum Mg is also associated with less deterioration of renal function in diabetics. Depression, a comorbiditity of diabetes, is less prevalent in patients with high serum Mg. A standardized regimen for diagnosing Mg-depletion and a regimen for supplementing these patients is outlined. Diagnosis of Mg depletion is simple predominantly by synoptic view of anamnestic, clinical or/and laboratory data.

 
  • Literatur

  • 1 Von Ehrlich B, Barbagallo M, Classen HG et al. Leitlinie Magnesium und Diabetes. Nieren-Hochdruckkrkh 2009; 38: 633-635
  • 2 ESC-Guideline: Guidelines for the management of atrial fibrillation. Eur Heart J 2010; 31: 2369-2429
  • 3 Barbagallo M, Dominguez LJ. Magnesium metabolism in type 2 diabetes mellitus, metabolic syndrome and insulin resistance. Arch Biochem Biophys 2007; 458: 40-47
  • 4 Barbagallo M, Dominguez LJ, Galioto A et al. Role of magnesium in insulin action, diabetes and cardio-metabolic syndrome X. Mol Asp Med 2003; 24: 39-52
  • 5 Resnick LM, Gupta RK, Gruenspan H et al. Hypertension and peripheral insulin resistance. Possible mediating role of interacellular free magnesium. Am J Hypertens 1990; 3: 373-379
  • 6 Xu J, Xu W, Yao H et al. Association of serum and urinary magnesium with the pre-diabetes, diabetes and diabetic complications in the chinese northeast population. PLOS ONE 2013; 8 online publication
  • 7 Huang JH, Lu YF, Cheng FC et al. Correlation of magnesium intake with metabolic parameters, depression and physical activity in elderly type II diabetes patients: a cross-sectional study. Nutrition Journal 2012; 11: 41-51
  • 8 Corica F, Corsonello A, Ientile R et al. Serum ionized magnesium levels in relation to metabolic syndrome in type 2 diabetic patients. J Am Coll Nutr 2006; 25: 210-215
  • 9 Takaya J, Higashino H, Kotera F et al. Intracellular magnesium of platelets in children with diabetes and obesity. Metabolism 2003; 52: 468-471
  • 10 Wälti MK, Zimmermann MB, Spinas A et al. Low plasma magnesium in type 2 diabetes. Swiss Med Wkly 2003; 133: 289-292
  • 11 Sjögren A, Floren CH, Nilsson A. Magnesium deficiency in IDDM related to level of glycosylated hemoglobin. Diabetes 1986; 35: 459-463
  • 12 Huerta MG, Roemmich JN, Kington ML et al. Magnesium deficiency is associated with insulin resistance in obese children. Diabetes Care 2005; 28: 1175-1181
  • 13 Rosolova H, Mayer O, Reaven GM. Insulin-mediated glucose disposal is decreased in normal subjects with relatively low plasma magnesium concentrations. Metabolism 2000; 49: 418-420
  • 14 Ma J, Folsom AR, Melnick SL et al. Associations of serum and dietary magnesium with cardiovascular disease, hypertension, diabetes insulin and carotid arterial wall thickness: The ARIC study. J Clin Epidemiol 1995; 48: 927-940
  • 15 He K, Liu K, Daviglus ML et al. Magnesium intake and incidence of metabolic syndrome among young adults. Circulation 2006; 113: 1675-1682
  • 16 Rumawas ME, McKeown NM, Rogers G et al. Magnesium intake is related to improved insulin homeostasis in the Framingham Offspring Cohort. J Am Coll Nutr 2006; 25: 486-492
  • 17 Rodriguez-Moran M, Gerrero-Romero F. Insulin secretion is decreased in non-diabetic individuals with hypomagnesiaemia. Diabetes Metab Res Rev 2011; 27: 590-596
  • 18 Paolisso G, Scheen A, Cozzolino D et al. Changes in glucose turnover parameters and improvenet of glucose oxidation after 4-week magnesium administration in elderly noninsulin-dependent (type II) diabetic patients. J Clin Endocrinol Metab 1994; 78: 1510-1514
  • 19 Paolisso G, Passariello N, Pizza G et al. Dietary magnesium supplements improve B-cell response to glucose and arginine in elderly non-insulin dependent diabetic subjects. Acta Endocr 1989; 121: 16-20
  • 20 Weng LC, Lee NJ, Yeh WT et al. Lower intake of magnesium and dietary fiber increases the incidence of type 2 diabetes in Taiwanese. J Form Med Assoc 2012; 111: 651-659
  • 21 Guerrero-Romero F, Rascon-Pacheco RA, Rodriguez-Moran M et al. Hypomagnesaemia and risk for metabolic glucose disorders: a 10-year follow-up study. Eur J Clin Invest 2008; 38: 389-396
  • 22 Larsson SC, Wolk A. Magnesium intake and risk of type 2 diabetes: a meta-analysis. J Intern Med 2007; 262: 208-214
  • 23 Van Dam RM, Hu FB, Rosenberg L et al. Dietary calcium and magnesium, major food sources, an risk of type 2 diabetes in U. S. Black Women. Diabetes Care 2006; 29: 2238-2243
  • 24 Lopez-Ridaura R, Willett WC, Rimm EB et al. Magnesium intake and risk of type 2 diabetes in men and women. Diabetes Care 2004; 27: 134-140
  • 25 Song Y, Manson JE, Buring JE et al. Dietary magnesium intake in relation to plasma insulin levels and risk of type 2 diabetes in women. Diabetes Care 2004; 27: 59-65
  • 26 Kao WHL, Folsom AR, Nieto FJ et al. Serum and dietary magnesium and the risk for type 2 diabetes mellitus. Arch Intern Med 1999; 159: 2151-2159
  • 27 Dong JY, Xun P, He K et al. Magnesium intake an risk of type 2 diabetes. Diabetes care 2011; 34: 2116-2112
  • 28 Bardicef M, Bardicef O, Sorokin Y et al. Extracellular and intracellular magnesium depletion in pregnancy and gestational diabetes. Am J. Obstet Gynecol 1995; 172: 1009-1013
  • 29 Speich M, Murat A, Classen HG et al. Longitudinal study of concentrations of plasma, erythrocyte and urine magnesium, calcium, phosphorus, potassium, zinc and copper during insulin-dependent diabetic pregnancy. Mag Bull 1993; 15: 39-43
  • 30 Kleinwechter H, Schäfer-Graf U, Bührer C et al. Gestationsdiabetes mellitus (GDM) – Diagnostik, Therapie u. Nachsorge. Diabetologie 2012; 7: S174-S184
  • 31 Jose B, Jain V, Vikram NK et al. Serum Magnesium in overweight children. Indian pediatrics 2012; 49: 109-112
  • 32 Celik N, Andiran N, Yilmaz AE. The relationship between serum magnesium levels with childhood obesity and insulin resistance: a review of the literature. J Pediatr Endocrinol Metab 2011; 24 (09) 675-678
  • 33 Mooren FC, Krüger K, Völker K et al. Oral magnesium supplementation reduces insulin resistance in non-diabetic subjects – a double-blind, placebo-controlled, randomized trial. Diabetes Obes Metab 2011; 13: 281-284
  • 34 Hadjistavri LS, Sarafidis PA, Georgianos PI et al. Beneficial effects of oral magnesium supplementation on insulin sensitivity and serum lipid profile. Med Sci Monit 2010; 16: 13-18
  • 35 Guerrero-Romero F, Tamez-Perez HE, Gonzalez-Gonzalez G et al. Oral magnesium supplementation improves insulin sensitivity in non-diabetic subjects with insulin resistance. A double-blind placebo-controlled randomized trial. Diabetes Metab 2004; 30: 253-258
  • 36 Rodriguez-Moran M, Guerrero-Romero F. Oral magnesium supplementation improves insulin sensitivity and metabolic control in type 2 diabetic subjects. Diabetes Care 2003; 26: 1147-1152
  • 37 Song Y, He K, Levitan EB et al. Effects of oral magnesium supplementation on glycaemic control in type 2 diabetes: a meta-analysis of randomized double-blind controlled trials. Diabet Med 2006; 23: 1050-1056
  • 38 Liao F, Folsom AR, Brancati FL. Is low magnesium concentration a risk factor for coronary heart disease? The Atherosclerosis Risk in Communities (ARIC) Study. Am Heart J 1998; 136: 480-490
  • 39 Barbagallo M, Dominguez LJ, Galioto A et al. Oral magnesium supplementation improves vascular function in elderly diabetic patients. Mag Res 2010; 23: 131-137
  • 40 Rasheed H, Elahi S, Ajaz H. Serum magnesium and atherogenic lipid fractions in type II diabetic patients of Lahore, Pakistan. Biol Trace Elem Res 2012; 148: 165-169
  • 41 Guerrero-Romero F, Rodriguez-Moran M. Hypomagnesemia is linked to low serum HDL-cholesterol irrespective of serum glucose values. J Diabetes Complications 2000; 14: 272-276
  • 42 Kisters K, Spieker C, Tepel M et al. New data about the effects of oral physiological magnesium supplementation on several risk factors (lipids and blood pressure). Magnes Res 1993; 6: 355-360
  • 43 Von Ehrlich B, Wadepuhl M. Erhöhtes Risiko einer diabetischen Retinopathie bei niedrigem Serum-Magnesium. Diabetes und Stoffwechsel 2003; 12: 285-289
  • 44 De Leeuw I, Engelen W, De Block C et al. Long term magnesium supplementation influences favourably the natural evolution of neuropathy in Mg-depleted type 1 diabetic patients (T1dm). Magnes Res 2004; 17: 109-114
  • 45 Engelen W, Bouten A, De Leeuw I et al. Are low magnesium levels in type 1 diabetes associated with electromyographical signs of polyneuropathy?. Magnes Res 2000; 13: 197-203
  • 46 Lima M, Cruz T, Pousada JC et al. The effect of magnesium supplementation in increasing doses on the control of type 2 diabetes. Diabetes card 1998; 21: 682-686
  • 47 Pham PC, Pham PM, Pham PT. Patients with diabetes mellitus type 2 and hypomagnesemia may have enhanced glomerular filtration via hypocalcemia. Clin Nephrol 2012; 78: 442-448
  • 48 Prabodh S, Prakash DSRS, Sudhakar G et al. Status of copper and magnesium levels in diabetic nephropathy cases: a case-control study from south india. Biol Trace Elem Res 2011; 142: 29-35
  • 49 Pham PC, Pham PM, Pham PT et al. The link between lower serum magnesium and kidney function in patients with diabetes mellitus type 2 deserves a closer look. Clin Nephrol 2009; 71: 375-379
  • 50 Pham PCT, Pham PMT, Pham PAT et al. 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
  • 51 Barragan-Rodriguez L, Rodriguez-Moran M, Guerrero-Romero F. Depressive symptoms and hypomagnesemia in older diabetic subjects. Arch Med Res 2008; 38: 752-756
  • 52 Barragan-Rodriguez L, Rodriguez-Moran M, Guerrero-Romero F. Efficacy and safety of oral magnesium supplementation in the treatment of depression in the elderly with type 2 diabetes: a randomized, equivalent trial. Magnes Res 2008; 21: 218-223
  • 53 Vierling W, Liebscher DH, Micke O et al. Magnesiummangel und Magnesiumtherapie bei Herzrhythmusstörungen. Dtsch Med Wochenschr 2013; 138: 1165-1171
  • 54 Classen HG, Gröber U, Kisters K. Magnesium-Mangel und Arzneimittel. MMP 2012; 35: 274-280
  • 55 Curiel-Garcia JA, Rodriguez-Moran M, Guerrero-Romero F. Hypomagnesemia and mortality in patients with type 2 diabetes. Magnes Res 2008; 21: 163-166
  • 56 Spätling L, Classen HG, Külpmann WR et al. Diagnostik des Magnesiummangels. Fortschritte der Medizin 2000; 118: 49-53
  • 57 Atsmon J, Doley E. Drug-induced hypomagnesaemia: scope and management. Drug Saf 2005; 28: 763-788
  • 58 Ismail Y, Ismail AA, Ismail AAA. The underestimated problem of using serum magnesium measurements to exclude magnesium deficiency in adults; a health warning is needed for “normal” results. Clin Chem Lab Med 2010; 48: 323-327
  • 59 Porta S, Gell H, Porta J et al. Evidence of progress and success of Magnesium substitution by correlating Mg dynamics and metabolic parameters. Trace Elements and Electrolytes 2013; 30: 87-93
  • 60 Altura BT, Burack JL, Cracco RQ et al. Clinical studies with the NOVA ISE for IMg2+. Scand J Clin Lab Invest Suppl 1994; 217: 53-67
  • 61 Resnick LM, Altura BT, Bupta RK et al. Intracellular and extracellular magnesium depletion in type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 1993; 36: 767-770
  • 62 Cunningham J, Rodriguez M, Messa P. Magnesium in chronic kidney disease stages 3 and 4 and in dialysis patients. Clin Kidney J 2012; 5 (Suppl. 01) i39-i59