Rajiv Gandhi Institute of Health Sciences

Karnataka, Bangalore

M. D (BIOCHEMISTRY)

Sri Devaraj Urs Medical College

Tamaka, Kolar – 563 101

A STUDY OF SERUM MAGNESIUM, GLYCATED HEMOGLOBIN, LIPID PROFILE

AND MICROALBUMINURIA IN DIABETIC

OPTHALMIC COMPLICATIONS 1.RETINOPATHY

2. CATARACT

By:

Dr. NAVIN S

Dept. of BIOCHEMISTRY

Sri Devaraj Urs Medical College

Tamaka, Kolar – 563 101

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
ANNEXURE- II
REGISTRATION OF SUBJECT FOR DISSERTATION
1. / Name of the candidate and address : DR. NAVIN S
PLOT NO 58, BHAGYA NAGAR,
SEDAM ROAD GULBARGA
2. / Name of the institution : SRI DEVARAJ URS MEDICAL COLLEGE
TAMAKA, KOLAR.
3. / Course of study & subject : MD BIOCHEMISTRY
4. / Date of admission to course : 31.5.2007
5. / Title of the topic : A STUDY OF SERUM MAGNESIUM, GLYCATED
HEMOGLOBIN, LIPID PROFILE AND
MICROALBUMINURIA IN DIABETIC OPTHALMIC
COMPLICATIONS
  1. RETINOPATHY
  2. CATARACT

6. / BRIEF RESUME OF THE INTENDED WORK:
6.1 Need for the study:
Magnesium is a divalent cation, with a molecular weight 34.305. It acts as a cofactor for many kinase enzymes in the body. Kinase enzymes are involved in the energy generation pathways mainly carbohydrate metabolism. Clinicians used to get routine blood and urine examination such as, blood glucose levels, glycated hemoglobin and benedicts test in urine for diabetic patients. Electrolytes, particularly magnesium even though involved in carbohydrate metabolism, was not taken into consideration to find out the status of
diabetes. It has been observed that decreased levels of magnesium causes decreased activity of kinase
enzymes which in turn lead to altered carbohydrate metabolism that leads to hyperglycemia in diabetes. Increased glucose levels in our body lead to flux this excess glucose to take an alternate pathway and getting converted to sorbitol.
Sorbotil is a hygroscopic compound, which gets deposited in retina, lens, glomerular basement membrane and peripheral nerves leading to complications of diabetes such as retinopathy, cataract, nephropathy and peripheral neuropathy respectively.
Implication of magnesium in causation of diabetic complications is less studied and is not clear till now. The finding whether decreased magnesium levels in diabetic complication is a cause or a consequence is less well understood. In view of this we are planning to do a present study in diabetic retinopathy and diabetic cataract patients in comparison to non diabetic healthy controls
6.2 Review of literature:
Magnesium is the fourth most abundant divalent cation in the body and second most abundant in the intracellular fluid. Magnesium has been implicated in various biochemical functions1. Magnesium is involved in multiple levels of insulin secretion, binding and activity. Magnesium activates more than 300 enzymes in body and is a critical cofactor of many enzymes in carbohydrate metabolism. One of its well understood function is to involve as a cofactor for the enzymes of energy metabolism. Cellular magnesium has been shown to influence the activity of Na+-K+ ATPase that plays a major role in the maintenance of sodium and potassium gradient as well as across the cell membrane. Cellular magnesium deficiency can alter the activity of membrane bound Na+-K+ ATPase which is involved in maintenance of gradients of Na2+, K+ and in glucose transport2,3. The utilization of glucose by peripheral tissues is dependent on insulin4. Serum magnesium levels has been shown to influence the secretion, binding and activity of insulin2,3. In fact, it has been shown that there is a direct relationship between serum magnesium level and
cellular glucose utilization related to increase sensitivity of tissues to insulin5. The above studies indicate
the central role of magnesium in the utilization of glucose.
The exact cause of diabetic hypomagnesaemia is unclear; it has been observed that increase urinary loss of magnesium may contribute to it. Two factors may work together in this respect, namely, the osmotic action of glycosuria as well as hyperglycemia per se, the latter being known to depress the net tubular resorption of magnesium in normal man. Measurement of magnesium levels in serum has been done in a variety of diseases such as acute myocardial infraction, atherosclerosis, hypertension, renal tubular disorders and diabetes mellitus in particular which may be a consequence of diabetes1. Hypomagnesaemia has been reported in diabetic patients with poor glycemic control, which ultimately leads to these complications6.
6.3 Objectives of study:
  1. To screen diabetic retinopathy and diabetic cataract patients for serum magnesium levels.
  2. To screen diabetic retinopathy and diabetic cataract patients for microalbuminuria.
  3. To evaluate the correlation between serum magnesium levels with glycated hemoglobin, lipid profile and microalbuminuria in patients with diabetic retinopathy and diabetic cataract.

7. / MATERIALS AND METHODS:
7.1Source of data:
Study group
Inclusion criteria.
  1. Clinically proven cases of diabetes with diabetic cataract and diabetic retinopathy attending at ophthalmology OPD, RL JALAPPA HOSPITAL AND RESEARCH CENTRE, KOLAR. About 50 – 100 patients in each group will be included in our study over a period of one year from Dec 2007 to June 2009.
Exclusion criteria
  1. Non diabetic cases
  2. Diabetics with other complications such as neuropathy, nephropathy, hypertension and other vascular complications.
  3. Diabetic patients with any other concurrent chronic disease such as cardiac diseases, thrombotic stroke etc
  4. Gestational diabetes mellitus.
Control group
  1. Age and sex matched normal, physically healthy volunteers, with no history of diabetes mellitus for any other chronic diseases.
  2. Control group will be screened for the same parameters which are done for cases and if the values fall within the normal reference range, they will be included as control.
  3. If any abnormality is found in these parameters they will be excluded from the control group.

7.2 Method of collection of data:
  1. After obtaining informed consent, 5ml of blood from the study and the control group will be drawn under full aseptic precautions.
  2. Two samples, 8hrs fasting and 2hrs post prandial, will be collected for analysis.
  3. Samples will be collected in the fluoride tube and used for estimation of blood glucose and glycated hemoglobin.
  4. Serum from the remaining sample is used for the estimation of magnesium, lipid profile and renal parameters.
  5. Urine samples will also be collected from both the groups for corresponding sugars and micro total protein.
  1. The parameters are estimated using the following techniques.
  1. Serum magnesium by Calmagite dye method.
  1. Gylcated hemoglobin by Cation exchange resin method.
  2. Blood glucose by Glucose oxidase enzymatic method.
  3. Triglycerides by enzymatic method using Glycerol-3-phosphate as substrate
  4. Total cholesterol by Cholesterol oxidase - peroxidase method.
  5. HDL cholesterol by Precipitation (with phosphotungstic acid) method.
  6. LDL cholesterol using Fried wald formula
LDL = TC – (HDL + TG/5)
  1. Blood urea by Specific Urease method.
  2. Serum creatinine by end point Jaffe method.
  3. Microalbuminuria by Immunotubimetric method.
Statistical analysis
The data collected will be tabulated and analyzed using descriptive statistical tool, mean, standard deviation, and comparison between the groups by using student ‘t’ test and correlation analysis. Complete analysis will be carried out using SPSS package.
7.3 Does the study require any investigations or interventions to be conducted on
Patients or other humans or animals? If so, please describe briefly.
Yes, the study requires investigations to be conducted on patients as mentioned above after obtaining the informed consent from patients.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes, the ethical clearance has been obtained from the Ethical Clearance
Committee of Sri Devaraj Urs Medical College, Kolar.
8. / LIST OF REFERENCES:
  1. Ellin JR. Magnesium: The fifth but forgotten electrolyte. Am. J.Clin Pathol. 1994; 102: 616-622.
  2. Grofton G and Borter MA. The role magnesium in diabetes mellitus. J Diabetes complications. 1992; 6: 143-149.
  3. Durlach J, Altura B and Altura BM. Highlights and summary of the 10th Annual French Colloquium on magnesium. Magnesium. 1983; 2: 330-336.
  1. David B Sacks.Carbohydrates. In:Burtis CA, Ashwood ER, Border, editors. Tietz text book of Clinical Chemistry. Philadelphia: WB Saunders and company, 5th edition, 2001: 427-461.
  2. Yajnikcs CS, Smith RF, Hockaday TDR and Ward NI. Fasting plasma
Magnesium concentration and glucose disposal in diabetes. B.M.J. 1984;
288: 1032-1034.
  1. Khan LA, Alam AMS, Ali L, Goswami A, etal. Serum and urinary magnesium in young diabetic subjects in Bangladesh. American Journal of Clinical Nutrition. 1999; 69(1): 70-73

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12. / SIGNATURE OF THE CANDIDATE :
REMARKS OF THE GUIDE: Study of Magnesium in serum and Microalbuminuria in these patients will also help in early detection of nephropathy, as it is one of the earliest complication of diabetes mellitus.
11.1) NAME AND DESIGNATION: DR. H. V. SHETTY
OF GUIDE PROFESSOR AND HEAD OF THE DEPARTMENT,
DEPT OF BIOCHEMISTRY
SDUMC, TAMAKA, KOLAR.KARNATAKA.
11.2) Signature
11.3) Co-Guide :
11.4) Signature
11.5) Head of Department : DR. H. V. SHETTY
DEPT OF BIOCHEMISTRY
SDUMC, TAMAKA, KOLAR, KARNATAKA.
11.6) Signature
12.1) Remarks of Chairman and Principal
12.2) Signature