Annexure – I

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCESBANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / Name of the candidate
and address
(in block letters) / DR.KAPIL CHAWLA
MVJ MC & RH
BOYS HOSTLE, ROOM NO. G-3
DANDUPALYA,HOSKOTE,BANGALORE- 562114
KARNATAKA.
2. / Name of the institution / M.V.JMEDICALCOLLEGE AND RESEARCHHOSPITAL.
3. / Course of study and subject / M.D (GENERAL MEDICINE)
4. / Date of admission to course / 26MAY,2010
5. / Title of the Topic :
A CROSSECTIONAL STUDY OF FASTING SERUM MAGNESIUM LEVELS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN RELATION TO ITS COMPLICATIONS
6. / Brief resume of the intended work:
6.1. Need for the study:
. Magnesium is an essential element and has a fundamental role in carbohydrate metabolism in general and in the insulin action in particular. Magnesium is a cofactor in both glucose transport mechanism of the cell membranes and for various intracellular enzymes involved in carbohydrate oxidation The concentrations of magnesium in serum of healthy people are remarkably constant, whereas 25-39% of diabetics have low concentrations of serum magnesium. Magnesium depletion has a negative impact on glucose homeostasis and insulin sensitivity in patients with type 2 diabetes, as well as on the evolution of complications such as ischemic heart disease, arterial atherosclerosis, hypercholesterolemia, hyper triglyceridemia, hypertension, retinopathy, neuropathy and nephropathy. Moreover, low serum magnesium is a strong, independent predictor of development of type 2 diabetes.
6.2. Review of literature:
1. Monika K.Walti and colleagues determined plasma magnesium concentrations in 109 type 2 diabetic patients and 156 non-diabetic controls matched for age and sex.They found that plasma magnesium concentrations were below the normal reference range in 37.6% of the diabetic
patients and 10.9% of the control subjects. They concluded that low plasma magnesium concentrations are common in type 2 diabetics .
2. Istar kareem and colleagues studied 100 subjects, 30 diabetics without complications, 40 diabetics with retinopathy and 30 non diabetic as normal control group. Blood sugar levels, magnesium were correlated with degree of diabetic control from the levels of glycosylated hemoglobin. Serum magnesium levels in diabetics with retinopathy were found to be significantly lowered than in diabetics without complications. Also diabetics without complications showed hypomagnesemia when compared with normal control group.
3. R D Ankush, et al. undertook a study to evaluate the levels of plasma magnesium, lipid peroxides, nitric oxide endproducts, erythrocyte membrane lipid peroxides, erythrocyte reduced glutathione and erythrocyte superoxidedismutase activity in type-2 diabetes mellitus patients. 60 patients with type-2 diabetes mellitus and 30 healthycontrol subjects were included in this study.Decreased levels of plasma magnesium,erythrocyte reduced glutathione and erythrocyte superoxide dismutase activity while increased levels of plasmalipid peroxides, nitric oxide end products and erythrocyte membrane lipid peroxides were observed in patientswith type-2 diabetes mellitus. They proposed that, under the shadow of hypomagnesaemia, there is excessiveproduction of reactive oxygen species and reactive nitrogen species as reflected by elevated lipid peroxidesand nitric oxide end products concomitant with dwindled antioxidants and suggested their association with latecomplications in type-2 diabetes mellitus.
4. W.H Lindo Kao, et. al assessed the risk for type 2 diabetes associatedwith low serum magnesium level and low dietarymagnesium intake in a cohort of nondiabetic middleaged adults (N = 12,128) from the Atherosclerosis Riskin Communities Study during 6 years of follow-up. Fastingserum magnesium level, anddietary magnesium intake, weremeasured at the baseline examination. It was found that among white participants, a graded inverse relationshipbetween serum magnesium levels and incidenttype 2 diabetes was observed. They concluded that among white participants, low serummagnesium level is a strong, independent predictor ofincident type 2 diabetes. That low dietary magnesiumintake does not confer risk for type 2 diabetes impliesthat compartmentalization and renal handling of magnesiummay be important in the relationship between low serum magnesium levels and the risk for type 2 diabetes.
5. Cristiane Hermes sales and Lucia de Fatima Campos Pedrosa have stated in their article that hypomagnesemia in diabetes is usually observed in patients with deficient metabolic control or associated with chronic complications of diabetes, according to clinical & epidemiological studies. The responsible mechanisms for magnesium deficiency in patients with diabetes have still not been clarified. The scientific evidences indicate the role of calcium and magnesium as mediators of the insulin action. Hyperglycemia per se elevates intracellular calcium and suppresses intracellular magnesium in normal human red cells. Low availability of intracellular magnesium diminishes the tyrosine kinase activity and increases the vascular constriction mediated by calcium, hindering the relaxation of cardiac and smooth muscles, and this way, interfering in the useage of cellular glucose. Such mechanism contributes to raise the blood pressure and peripheral insulin resistance. Low plasma concentration of magnesium and reduced antioxidative protection in diabetics plays a role in the development of chronic complications, micro and macrovascular complications.
6.3. Objectives of the study:
  1. To estimate fasting serum magnesium levels in patients with type 2 diabetes mellitus.
  1. To correlate serum magnesium concentrations with micro and macrovascular complications of type 2 diabetes mellitus - retinopathy, nephropathy, neuropathy and ischemic heart disease.
Materials and Methods:
7.1.Source of data
Patients with type 2 diabetes admitted in MVJMC&RH
7.2. Method of collection of data (including sampling procedure, if any):
50 patients with type 2 diabetes admitted in MVJMC&RH and 25 controls would undergo:
FBS, PPBS, serum magnesium levels, 24hrs urinary protein, blood urea, serum creatinin, urine routine, ECG, fundoscopy.
1)Inclusion criteria:
All cases of type 2 diabetes mellitus admitted in MVJMC&RH
2)Exclusion criteria:
1. Patients with chronic renal failure.
2. Acute myocardial infarction in last 6 months.
3. Patients on diuretics.
4. Patients receiving magnesium supplements or magnesium containing antacids.
5. Malabsorption or chronic diarrhea.
6. Patients with history of alcohol abuse.
7. Pregnant women with hypertension, proteinuria and eclampsia.
8. patients with history of epilepsy.
7.3. Does the study require any investigation or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.
Yes, investigations would be done after taking the written informed consent of the patient
.
7.4. Has ethical clearance been obtained from your institution in case of 7.3?
Yes
8. / List of references:
  1. Monika K. Wältia, Michael B. Zimmermanna, Giatgen A. Spinasb, Richard F. Hurrella.Low plasma magnesium in type 2 diabetes.SWISS MED WKLY 2003 ; 133 : 289 – 292 .
2.Ishrat Kareem, S.A. Jaweed, J.S. Bardapurkar, V.P. Patil. Study of magnesium, glycosylated haemoglobin and lipid profile in diabetic retinopathy. Indian Journal of Clinical Biochemistry, 2004, 19 (2) 124-127.
3 R D Ankush, A N Suryakar and N R Ankush. Hypomagnesaemia in type-2 diabetes mellitius patients: A study of oxidative and nitrosative stress.Indian Journal of Clinical Biochemistry, 2009 / 24 (2) 184-189.
4.W. H. Linda Kao et,al. Serum and Dietary Magnesium and the Riskfor Type 2 Diabetes Mellitus
The Atherosclerosis Risk in Communities Study Arch Intern Med. 1999;159:2151-2159.
5. Cristiane Hermes Sales, Lucia de Fatima Campos Pedrosa. Magnesium and diabetes mellitus: Their relationClinical Nutrition (2006) 25, 554-562.
9. / Signature of Candidate
10. / Remarks of the Guide:The topic and title of the dissertation is good, good to study in the setting of rural area and large group of people involvement. It is an enlightment for the future study.
11. / Name & Designation of :
(in block letters)
11.1 Guide: / DR. VENKATESHAPPA
ASSOCIATE PROFESSOR
DEPARTMENT OF MEDICINE
MVJMC&RH
11.2 Signature
11.3 Co-Guide (if any)
11.4 Signature
11.5 Head of Department / MVJMC&RH.
DR.P.CHANDRASHEKHRA
HOD & PROFESSOR DEPATMENT OF MEDICINE
MVJMC&RH
11.6 Signature
12. / 12.1 Remarks of the Chairman And Principal :
12.2 Signature