Magnesium, fibrinolysis and clotting interplay among children and adolescents with type 1 diabetes mellitus; potential mediators of diabetic microangiopathy.

BACKGROUND AND AIM: Hypomagnesemia and clotting disorders have been reported among people with diabetes especially those with type 2 diabetes (T2DM). Magnesium plays a crucial role in hemostasis and hypomagnesemia was found to increase the thrombotic risk. The patho-mechanism linking magnesium, clotting disorders, and diabetic microangiopathy in T1DM remains to be unraveled. Hence this study aimed to assess the magnesium level among children and adolescents with T1DM compared to healthy controls and to correlate it with coagulopathy markers and diabetic microangiopathy.

METHODS

Forty-six children and adolescents with T1DM & 46 controls were assessed for serum magnesium, prothrombin time (PT), activated-partial thromboplastin time (aPTT), plasminogen activator inhibitor-1 (PAI-1) and HbA1c. The Toronto clinical scoring system, fundus, urinary microalbumin, and serum fasting lipids were used to assess diabetic microangiopathy.

RESULTS

Children and adolescents with T1DM have significantly lower magnesium, PT, aPTT, and significantly higher PAI-1 than controls (p<0.001), this is more evident in those having microangiopathy than those without (p<0.001). Serum magnesium is positively correlated with PT, aPTT, and HDL and negatively correlated with insulin daily dose, PAI-1, HbA1c, triglycerides, and urinary microalbumin. Multivariate-logistic regression revealed that diabetes duration, HbA1c, PT, aPTT, PAI-1, and urinary microalbumin were independently associated with serum magnesium among children and adolescents with T1DM (p<0.05).

CONCLUSION

Children and adolescents with T1DM have lower magnesium levels than controls; that is more pronounced among those having microangiopathy. Low serum magnesium is associated with poor glycemic control, coagulopathy, and diabetic microangiopathy among children and adolescents with T1DM. Magnesium supplementation combined with standard insulin therapy in pediatric patients with T1DM is recommended for better glycemic control and prevention of diabetic microangiopathy.