Ionized serum magnesium in type 2 diabetes mellitus: its correlation with total serum magnesium and hemoglobin A1c levels

BACKGROUND: Hypomagnesemia has been described in diabetes mellitus. We sought to compare serum total and ionized magnesium (Mg) levels in patients with type 2 diabetes with control subjects and to determine the relationship between diabetes control, as assessed by hemoglobin A1c (Hb A1c) and Mg (total and ionized). METHODS: Serum ionized Mg was measured by ion-selective electrode (ISE) method using the NOVA electrode. RESULTS: Serum ionized Mg was significantly higher in diabetics than in control subjects, whereas no difference was found in total Mg. Serum ionized Mg correlated with total Mg in diabetics and in control subjects. There was an inverse correlation between total Mg and Hb A1c; the correlation was not statistically significant between ionized Mg and Hb A1c. CONCLUSIONS: Our data do not support routine Mg supplementation or monitoring in type 2 diabetes.     

Magnesium in disease: a review with special emphasis on the serum ionized magnesium.

This review deals with the six main clinical situations related to magnesium or one of its fractions, including ionized magnesium: renal disease, hypertension, pre-eclampsia, diabetes mellitus, cardiac disease, and the administration of therapeutic drugs. Issues addressed are the physiological role of magnesium, eventual changes in its levels, and how these best can be monitored. In renal disease mostly moderate hypermagnesemia is seen; measuring ionized magnesium offers minimal advantage. In hypertension magnesium might be lowered but its measurement does not seem relevant. In the prediction of severe pre-eclampsia, elevated ionized magnesium concentration may play a role, but no unequivocal picture emerges. Low magnesium in blood may be cause for, or consequence of, diabetes mellitus. No special fraction clearly indicates magnesium deficiency leading to insulin resistance. Cardiac diseases are related to diminished magnesium levels. During myocardial infarction, serum magnesium drops. Total magnesium concentration in cardiac cells can be predicted from levels in sublingual or skeletal muscle cells. Most therapeutic drugs (diuretics, chemotherapeutics, immunosuppressive agents, antibiotics) cause hypomagnesemia due to increased urinary loss. It is concluded that most of the clinical situations studied show hypomagnesemia due to renal loss, with exception of renal disease. Keeping in mind that only 1% of the total body magnesium pool is extracellular, no simple measurement of the real intracellular situation has emerged; measuring ionized magnesium in serum has little added value at present.     

2型糖尿病合并高血压患者胰岛素低抗

The fasting glucose(FBG),TG,CHO,HDL,LDL,ApoA1,ApoB,FIn and insulin sensitiviry index in patients with with type II diabetes mellitus complicated with hypertension were evaluated in the current study.The relationship between hypertension and abnomal level of blood lipid and insulin resistance. 1 Subjects and methods 1.1 Subjects 114 patients with type II diabetes mellitus were selected according to the WHO standards.All the patients were divided into 2 groups,normal blood pressure gr…     

高频超声检测高血压及高血压合并糖尿病患者血管内皮依赖性舒张功能

目的利用高分辨力超声技术对原发性高血压及高血压合并糖尿病患者的内皮依赖性血管舒张功能进行研究和分析.方法采用高频超声技术,对72例患者[其中25例原发性高血压患者(EH),25例高血压合并糖尿病患者(EH DM)和22例正常血压血糖患者(NT)]的血管内皮依赖性舒张功能进行测定评价,并测定其血浆一氧化氮(NO)内皮素(ET)血栓素B2(TXB2)和前列腺环素(PGI2)等血管活性物质的浓度变化.结果发现EH DM和EH组肱动脉血流介导的血管舒张百分率FMD(%)均较NT组明显减弱(P均<0.001),EH DM组又较EH组明显减弱(P=0.021),而3组比较对硝酸甘油的反应无显著性差异(P均>0.05).EH DM及EH组血浆NO,PGI2水平均较NT组减低(P均<0.01),EH DM组又较EH组明显降低(P=0.027).结论高血压患者存在血管内皮依赖性舒张功能受损,高血压合并糖尿病时,内皮功能损伤进一步加重,高频超声是评价血管内皮依赖性舒张功能的简单、无创、可靠的方法.     

代谢综合征与冠心病的载脂蛋白E基因多态性

目的:探讨代谢综合征(metabolicsyndrome,MS)与冠心病(coronaryarterydisease,CHD)的载脂蛋白E(apolipoproteinE,ApoE)基因多态性之间的关联。方法:将203例原发性高血压、糖尿病或原发性高血压合并糖尿病的患者分为代谢综合征组(按WHO定义,MS+,n=96)和非代谢综合征组(MS-,n=107);冠心病组(CHD+,n=84)和非冠心病组(CHD-,n=119);代谢综合征合并冠心病(MS++CHD,n=55)及代谢综合征非合并冠心病组(MS+,n=39)。采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)确定特定ApoE片段基因型,应用荧光标记自动测序法测定PCR产物,确认单核苷酸多态性(singlenucleotidepolymorphisms,SNPs)位点。结果:(1)MS组ApoEε4等位基因频率高于对照组(15.6%vs8.9%,P=0.038);(2)CHD组ε4等位基因频率显著高于对照组(16.8%vs8.8%,P=0.017);(3)MS+CHD组ε4等位基因频率显著高于对照组(21.8%vs7.3%,P=0.006);与...     

2型糖尿病合并高血压患者血清D-二聚体的表达

目的研究2型糖尿病合并高血压患者与单纯2型糖尿病患者血浆D-二聚体浓度的不同。方法将85例研究对象分为3组：正常对照组：20例;无高血压的2型糖尿病组：21例;2型糖尿病合并高血压组：44例。测定其血浆D-二聚体浓度并比较组间差异,检测结果数据以均数±标准差表示,组间比较采用方差分析（使用SPSS13．0软件）。结果正常对照组血浆D．二聚体浓度为（102．15±32．48）μg／L,无高血压的2型糖尿病组为（148．62±80．99）μg／L,2型糖尿病合并高血压组为（206．28±92．99）μg／L,无高血压的2型糖尿病组与正常对照组比较,D-二聚体浓度明显升高,差异有统计学意义（P〈0．05）;2型糖尿病合并高血压组与正常对照组比较,D-二聚体浓度也明显升高,差异有统计学意义（P〈0．01）;无高血压的2型糖尿病组与合并高血压组比较差异有统计学意义（P〈0．05）。结论血浆D-二聚体浓度在2型糖尿病及合并高血压患者中明显升高,这可能与凝血和纤溶系统失衡有关,在2型糖尿病及合并高血压患者中监测血浆D-二聚体浓度可能对于预防血栓性疾病有重要的临床意义。     

老年高血压合并糖尿病患者颈动脉超声研究

目的观察老年高血压合并糖尿病患者颈动脉粥样斑块的超声声像图特点。方法老年患者80例,分为三组：单纯高血压组（EH组）29例,高血压合并糖尿病（EH合并DM组）21例,正常对照组30例。所有病例均接受颈动脉超声检查、血糖及血胰岛素超敏C反应蛋白（hs—CRP）。颈动脉观察指标包括：内膜中层厚度（IMT）及粥样斑块的厚度,并计算Crouse积分。结果与对照组比较,高血压者颈总动脉IMT、颈动脉分叉处IMT、Crouse积分显著增高;EH合并DM组颈总动脉IMT、Crouse积分显著高于EH组（P〈0．01）。颈动脉斑块积分与胰岛素抵抗指数（HoMA—IR）、体重指数（BMI）和空腹血糖呈正相关。结论超声能很好反映老年高血压合并糖尿病患者颈动脉粥样硬化的程度,糖尿病和高血压同时存在时可加速动脉粥样硬化的进展。     

抵抗素与老年糖尿病合并高血压的相关性研究

目的 探讨抵抗素对老年糖尿病合并高血压的影响及其与相关代谢指标的关系.方法 将153例2型糖尿病分为合并高血压组70例和单纯糖尿病组83例,并选取同期健康体检55例老年人作为健康对照组.均测定体质量指数（BMI）、空腹血糖（FBG）、餐后2h血糖（2 h PG）、空腹胰岛素（FINS）、糖化血红蛋白（HbA1c）、胰岛素抵抗指数（HOMA-IR）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、甘油三酯（TG）及抵抗素水平,分析抵抗素与其他各项代谢指标的相关性.结果 与健康对照组比较,合并高血压组和单纯糖尿病组2hPG、BMI、FBG、FINS、HOMA-IR、HbA1c、TG及血清抵抗素水平均明显升高,HDL-C明显下降,差异均有统计学意义（P ＜0.01,P＜0.05）;与单纯糖尿病组比较,合并高血压组HOMA-IR、血清抵抗素水平明显升高,差异有统计学意义（P＜0.05）;血清抵抗素水平与BMI、HOMA-IR呈显著正相关（r =0.278,P=0.034;r =0.492,P=0.000）.结论 老年2型糖尿病合并高血压患者血清抵抗素水平明显升高,提示血清抵抗素可能通过某种机制和途径促进糖尿病患者的动脉硬化进程,促发高血压.     

Serum 1,5-anhydroglucitol in normal subjects and in patients with insulin-dependent diabetes mellitus

The serum levels of 1,5-anhydroglucitol were measured by gas chromatography in normal subjects and in patients with type 1 (insulin-dependent) diabetes mellitus and compared with those found in some other common diseases. The identity of the compound was checked by thin-layer chromatography and by means of mass fragmentography. The mean level was 81 mumol/l (range 10-146 mumol/l, n = 139) in normal subjects and comparable levels were found in patients with rheumatic disease (n = 20) and in several patients with circulatory diseases. The level was less than 10 mumol/l in 44 patients with insulin-dependent diabetes mellitus, both in newly diagnosed cases and in patients with a long history of the disease with or without nephropathy. The compound did not appear in serum during near normoglycaemic periods elicited by continuous subcutaneous insulin infusion therapy, nor after successful kidney transplantation.     

Role of abdominal obesity in pathogenesis of insulin resistance syndrome

AIM: To study relationships between pathogenesis of obesity, essential hypertension (EH), hyperlipidemia, ischemic heart disease (IHD) and diabetes mellitus (DM) type II. MATERIALS AND METHODS: Glucose and insulin levels in blood, serum lipids were measured, glucose and prednisolone glucose tolerance tests were made in 75 patients with abdominal and 75 patients with gluteofemoral obesity. RESULTS: The results of the study of 75, 75, 763 and 340 patients with abdominal, gluteofemoral obesity, IHD and DM type II, respectively, show that pathogenesis of abdominal obesity, essential hypertension, hyperlipidemia, IHD, abnormal glucose tolerance and diabetes mellitus type II has common features: relative hypercorticoidism, insulin resistance and hyperinsulinemia. CONCLUSION: Abdominal obesity is the earliest symptom in composition of metabolic cardiovascular syndrome. Prevention or early treatment of this obesity can prevent or delay onset of diseases associated with this syndrome.     

脂蛋白(a)颗粒浓度评估原发性高血压患者心血管风险的临床价值[1]

摘要：目的?通过分析原发性高血压患者血清脂蛋白(a)[Lp(a)]颗粒浓度与质量浓度，探讨血清Lp(a)水平对高血压患者心血管疾病风险评估的预测价值。方法?选取122例原发性高血压患者，按照中国高血压防治指南分为高风险组96例、低风险组26例；分别检测血清Lp(a)颗粒浓度、质量浓度以及血脂等其他生化参数。采用多元Logistic回归分析血清Lp(a)颗粒浓度、质量浓度对高血压患者心血管疾病风险分层的预测比值比(OR)及其95%置信区间(CI)。结果?高风险高血压患者的血清Lp(a)颗粒浓度27.7(8.58，64.65)nmol/L、质量浓度148.00(54.00，338.50)mg/L均高于低风险患者5.80(2.75，14.53)nmol/L、42.50(23.75，84.00)mg/L，P均<0.001。相关性分析显示，高血压患者血清Lp(a)颗粒浓度、质量浓度呈正相关(r=0.979，P<0.001)，均与HDL-C浓度呈负相关(r=-0.233，P=0.012及r=-0.233，P=0.013)。多因素Logistic回归分析显示，血清Lp(a)颗粒浓度(OR=1.105，95%CI=1.017～1.199，P=0.018)、质量浓度(OR=1.016，95%CI=1.003～1.030，P=0.016)的升高与高血压患者心血管疾病风险的增高相关。结论?高心血管疾病风险的原发性高血压患者血清Lp(a)颗粒浓度、质量浓度高于低风险患者；Lp(a)颗粒浓度有望成为高血压患者心血管疾病风险分层体系的辅助指标。     

Intracellular and extracellular, ionized and total magnesium in pre-eclampsia and uncomplicated pregnancy.

Magnesium (Mg) and calcium (CA) concentrations in women with pre-eclampsia, women with an uncomplicated pregnancy and non-pregnant women were compared. Ionized serum magnesium and calcium concentrations and intracellular magnesium concentrations were measured in 15 pregnant women with severe pre-eclampsia, 34 uncomplicated pregnant women early, at midterm and preterm in their pregnancy and 24 non-pregnant women. The ionized calcium concentration did not chance during normal pregnancy or during pre-eclampsia relative to non-pregnant women. In contrast, elevated total and ionized magnesium serum concentrations were found in women with severe pre-eclampsia (total Mg = 0.85+/-0.11 mM, ionized Mg = 0.61+/-0.06 mM) relative to uncomplicated pregnant women (total Mg = 0.72+/-0.06 mM, ionized Mg = 0.53+/-0.03 mM). Total magnesium in pre-eclamptic women were similar to non-pregnant women. Intracellular ionized and total magnesium concentrations in mononuclear blood cells and erythrocytes were similar in pre-eclamptic women and women with uncomplicated pregnancy. Serum magnesium concentrations are elevated in severe pre-eclamptic women relative to women with uncomplicated pregnancy and are related to birth weight and gestational age at delivery. There may be a causal relationship since magnesium is involved in blood pressure regulation through an intracellular inhibition of NO synthase in endothelial cells.     

Increased serum malondialdehyde levels in chronic stage of ischemic stroke

Serum lipoperoxidation products such as malondialdehyde (MDA) reflect oxidative stress. There are contradictory results addressing the levels of lipoperoxidation products in chronic phase of ischemic stroke. In the present study, we aimed to determine the serum MDA levels in stroke patients 6 months after the cerebrovascular accident. We also compared serum MDA levels in two major groups of patients with ischemic stroke resulting from small vessel and large vessel diseases, respectively. Serum MDA levels of thirty-eight patients who had ischemic stroke (19 with atherothrombotic ischemic stroke and 19 with lacunar infarction) and 30 healthy volunteers were measured. While there was no significant difference in serum MDA levels between the chronic ischemic stroke subgroups (p = 0.795), the serum MDA levels of patients with atherothrombotic ischemic stroke (p < 0.001) or with lacunar infarction (p < 0.001) were significantly higher compared to the control group. We also demonstrated that serum MDA levels of the patients with and those without hypertension (p = 0.846), diabetes mellitus (p = 0.891), or dyslipidemia (p = 0.38) were not significantly different. In conclusion, serum MDA levels were elevated in chronic stroke patients with small or large vessel diseases. To the best of our knowledge, this is the first report showing that serum MDA levels of these two groups are not significantly different. Furthermore, serum MDA levels do not differ solely by the existence or nonexistence of hypertension, diabetes mellitus or hyperlipidemia.     

2型糖尿病合并高血压患者动态血压观察

目的探讨2型糖尿病对高血压患者的动态血压的影响。方法选取62例合并2型糖尿病的高血压患者及64例单纯高血压患者,行24h动态血压监测。结果2型糖尿病合并高血压患者昼夜节律消失率、24hSBP、NSBP、24hPP、NPP、NMBP明显高于单纯高血压组,差异有统计学意义（P〈0．05）。结论2型糖尿病合并高血压患者正常的杓型动态血压节律消失较明显,收缩压负荷、夜间收缩压升高明显。     

Abnormalities of calcium metabolism in essential hypertension

Calcium metabolism has been investigated in patients with essential hypertension and normal renal function to evaluate the renal calcium handling and the reported increase in renal calcium loss. In 55 hypertensive and 55 sex- and age-matched healthy normotensive subjects creatinine clearance, serum total and ionized calcium, plasma parathyroid hormone and 24 h urinary excretion of calcium, sodium and cAMP were measured. In a subgroup of 20 hypertensive patients and 20 controls the fasting calcium excretion rate was also measured. Both 24 h and fasting calcium excretion rates were higher in the hypertensive group; so also were plasma parathyroid hormone and urinary cAMP. Serum total and ionized calcium levels were not different in the two groups. After intravenous calcium infusion (15 mg 3 h-1 kg-1) in seven hypertensive patients and controls, the hypertensive patients excreted more calcium at all serum calcium concentrations. These results support the hypothesis of primary renal calcium leak in essential hypertension. Enhanced urinary calcium excretion rate may cause compensatory parathyroid overactivity.     

超声定量技术用于2型糖尿病颈动脉血管病变诊断

目的：探讨超声定量技术对2型糖尿病颈动脉病变的应用价值。方法：选择2型糖尿病患者40例，分为糖尿病无高血压组（20例）和糖尿病合并高血压组（20例），另选择10例正常人作为对照，应用高频超声和超声定量技术测量双侧颈总动脉后壁内中膜厚度（IMT）最大值（IMTmax）及平均值（IMTmean）。结果：3组研究对象的IMTmax和IMTmean在左、右颈总动脉之间均无显著差异，糖尿病合并高血压组IMTmax与糖尿病无高血压组无显著差异，糖尿病合并高血压组IMTmean显著大于糖尿病无高血压组。结论：应用超声定量技术能尽早及全面反映糖尿病和糖尿病合并高血压患者的颈动脉血管病变，其测定颈动脉内中膜平均厚度较最厚值更具优越性。     

Effect of moderate improvement in metabolic control on magnesium and lipid concentrations in patients with type 1 diabetes

OBJECTIVE: To evaluate the effect of clinically obtainable improvements in metabolic control in patients with type 1 diabetes on biochemical cardiovascular risk factors. RESEARCH DESIGN AND METHODS: Blood and 24-h urinary samples were obtained from 49 patients with type 1 diabetes before and after a run-in period and after 3 months of intervention, with frequent adjustment of insulin dosage according to measured blood glucose concentrations. RESULTS: The intervention caused a mean insulin dosage increment of 10%, a 20% decrease in fasting plasma glucose concentration, a 10% decrease in albumin corrected serum fructosamine, and a somewhat lesser decrease in HbAlc.A 14% decrease in the renal excretion of magnesium (Mg) was observed, but without a change in average serum Mg concentration. Serum HDL cholesterol increased 4%, and serum triglycerides decreased 10% as an average. Looking at individual patients, the decrease in serum triglycerides correlated with both the change in serum total Mg concentration and with the increase in insulin dosage. Using the change in serum total Mg concentration and in insulin dosage as independent variables in a multiple regression analysis, the coefficient of correlation with the decrease in serum triglycerides was 0.52. CONCLUSIONS: Moderate but clinically obtainable improvement of metabolic control in patients with type 1 diabetes seems to reduce the loss of Mg, increase serum HDL cholesterol, and decrease serum triglycerides. The decrease in serum triglycerides was associated with the change in serum total Mg concentration. These reductions in Mg loss and serum triglycerides might reduce the risk of developing cardiovascular disease in patients with type 1 diabetes.     

Analysis of the brain bioavailability of peripherally administered magnesium sulfate: A study in humans with acute brain injury undergoing prolonged induced hypermagnesemia

OBJECTIVE: Based on preclinical investigations, magnesium sulfate (MgSO4) has gained interest as a neuroprotective agent. However, the ability of peripherally administered MgSO4 to penetrate the blood-brain barrier is limited in normal brain. The current study measured the passage of intravenously administered Mg into cerebrospinal fluid in patients with brain injury requiring ventricular drainage. DESIGN: A prospective evaluation of the cerebrospinal fluid total and ionized magnesium concentration, [Mg], during sustained hypermagnesemia was performed. SETTING: Neurosciences intensive care unit at a major teaching institution. PATIENTS: Thirty patients with acute brain injury secondary to subarachnoid hemorrhage, traumatic brain injury, primary intracerebral hemorrhage, subdural hematoma, brain tumor, central nervous system infection, or ischemic stroke were studied. INTERVENTIONS: Patients underwent 24 hrs of induced hypermagnesemia during which total and ionized cerebrospinal fluid [Mg] was measured. Serum [Mg] was adjusted to 2.1-2.5 mmol/L. Cerebrospinal fluid [Mg] was measured at baseline, at 12 and 24 hrs after onset of infusion, and at 12 hrs following infusion termination. MEASUREMENTS AND MAIN RESULTS: At baseline, total (1.25 +/- 0.14 mmol/L) and ionized (0.80 +/- 0.10 mmol/L) cerebrospinal fluid [Mg] was greater than serum total (0.92 +/- 0.18 mmol/L) and ionized (0.63 +/- 0.07 mmol/L) [Mg] (p < .05). Total (1.43 +/- 0.13 mmol/L) and ionized (0.89 +/- 0.12 mmol/L) cerebrospinal fluid [Mg] was maximally increased by 15% and 11% relative to baseline, respectively, during induced hypermagnesemia (p < .05). CONCLUSIONS: Hypermagnesemia produced only marginal increases in total and ionized cerebrospinal fluid [Mg]. Regulation of cerebrospinal fluid [Mg] is largely maintained following acute brain injury and limits the brain bioavailability of MgSO4.     

卡维地洛治疗高血压合并糖尿病患者心律失常临床疗效与安全性的随机对照试验

目的探讨卡维地洛治疗高血压合并糖尿病患者的心律失常的临床疗效及安全性。方法选择2011年10月至2013年10月在河北医科大学附属哈励逊国际和平医院住院治疗的高血压合并糖尿病心律失常患者,随机分为试验组和对照组。对照组患者给予降糖、血管紧张素转换酶抑制剂降压等常规治疗,试验组在对照组用药基础上加用卡维地洛。观察、记录并分析两组患者治疗后的疗效和不良反应。结果共纳入140例患者,试验组和对照组各70例,对照组有10例失访,故最终试验组70例、对照组60例纳入分析。结果显示:试验组总有效率(χ2=8.320,P=0.004)和室性期前收缩的动态心电图改善情况(χ2=5.333,P=0.014)优于对照组,其差异均有统计学意义。两组患者治疗后血压和心率较治疗前均明显改善,且治疗后试验组与对照组血压和心率差异有统计学意义(P均<0.05),试验组更优。治疗过程中,试验组有3例出现消化道症状,但其症状轻微,均能自行缓解。结论卡维地洛治疗高血压合并糖尿病心律失常患者的临床治疗效果显著,安全有效,值得临床应用。     

Impact of associated conditions on glycemic control of NIDDM patients.

OBJECTIVE--To assess the impact of associated conditions (obesity, dyslipidemia, and hypertension) on the glycemic control of non-insulin-dependent diabetes mellitus (NIDDM) patients under home-life conditions. RESEARCH DESIGN AND METHODS--We analyzed the metabolic data of 271 NIDDM patients (89% Mexican American) screened in a population-based survey (the San Antonio Heart Study). RESULTS--Obesity was present in 77% of the patients, hypertension in 23%, hypertriglyceridemia (serum triglycerides greater than 2.9 mM) in 23%, and hypercholesterolemia (serum total cholesterol greater than 6.5 mM) in 14%. Forty percent of the patients had two or more comorbid conditions. With the use of a multiple linear regression model, which was adjusted for age, sex, ethnicity, distribution of body fat (waist-hip ratio), plasma insulin, and treatment (of both diabetes and hypertension), we found that the presence of higher serum triglyceride concentrations was associated with significantly higher plasma glucose levels both in the fasting state (1.4 mM, P less than 0.001) and 2 h after an oral glucose load (1.2 mM, P = 0.003). The presence of obesity, hypertension, or high serum cholesterol levels was not associated with significant changes in glycemic control. When the entire group was stratified by diabetes treatment (untreated n = 89, diet n = 75, oral agents n = 82, insulin n = 25) and after adjusting for age, sex, ethnicity, and waist-hip ratio, only fasting and 2-h plasma glucose and insulin concentrations were significantly different across treatment groups, with diet and oral agents being associated with higher fasting (P less than 0.001) and postglucose (P less than 0.005) plasma glucose levels and lower plasma insulin concentrations (P less than 0.005) compared with newly diagnosed patients. Neither serum lipids nor blood pressure differed across treatment. CONCLUSIONS--In NIDDM patients under home-life conditions, higher serum triglycerides are associated with higher fasting and postglucose hyperglycemia regardless of antidiabetic treatment. The presence of obesity, hypertension, or high serum cholesterol levels is not associated with significant changes in glycemic control.