Evaluation of the relationship between proton pump inhibitor use and magnesium in patients with HBA1C >7 and diagnosis of diabetes mellitus who applied to Dicle University Faculty of Medicine Endocrinology Clinic in the last year

Objective: In this study, our aim was to determine the rate of proton pump inhibitor (PPI) use and to investigate the association between PPI use and hypomagnesemia in patients over 18 years of age diagnosed with and treated for diabetes mellitus (DM) who visited the Endocrinology Clinic at Dicle University Medical Faculty Hospital between January 2023 and December 2023. Materials and Methods: In this study, data were retrospectively collected from the hospital information management system for 615 patients over the age of 18 who were diagnosed with and treated for diabetes mellitus at the Endocrinology Clinic of Dicle University Medical Faculty Hospital between January 2023 and December 2023. In this study conducted with 615 patients, the mean age of our patients was 53.4 ± 13.4 years. Our study group consisted of diabetic patients, 42% of whom were male, 58% female, and 53.9% were using proton pump inhibitors.The patients' age and gender, HbA1c, magnesium, calcium, parathyroid hormone, phosphorus, and vitamin D levels, as well as their PPI usage and DM treatment options, were assessed. The relationship between these markers and magnesium levels was analyzed. Findings: According to the results obtained, it was determined that 45.7% of males and 59.8% of females were using PPIs. The rate of PPI use among females was found to be higher than that of males. The mean magnesium level of all diabetic patients in our study group was determined as 1.9 ± 0.2 mg/dL in males and 1.8 ± 0.2 mg/dL in females. Magnesium levels in males were found to be higher than in females. The proportion of males with magnesium levels below 1.5 mg/dL and between 1.5–1.8 mg/dL was higher than that of females, while the proportion of males with magnesium levels between 1.8–2.6 mg/dL was lower than that of females. In other words, hypomagnesemia in females tends to be moderate, while it is more severe in males.We found hypomagnesemia in 35% of all patients in the group, with severe hypomagnesemia observed in 2.9% of them.To determine the factors affecting the magnesium levels of patients, a multiple linear regression analysis was performed using the backward method (Table 23). Seven models were generated to examine the effect of the specified variables on magnesium levels. It was determined that the variables in Model 7 (gender, HbA1C, PPI use, and insulin use) explained 51.5% of the variance in magnesium levels (R²=0.515; F=7.970; p<0.001). Being male (β=0.329) and insulin use (β=0.405) were found to positively predict magnesium levels (p<0.05). PPI use was determined to negatively predict magnesium levels (β=-0.434; p<0.05).When examining magnesium levels in terms of PPI use, the mean magnesium level of PPI users was determined to be 1.8 ± 0.2 mg/dL, while it was 2.0 ± 0.2 mg/dL in non-users. Magnesium levels in PPI users were found to be lower than in non-users. Hypomagnesemia was observed in 59.2% of PPI users.When controlling for gender and age, it was confirmed that the magnesium levels of PPI users were lower than those of non-users. Conclusion: Our study was designed to examine the rates of PPI use and the relationship between PPI use and hypomagnesemia among patients diagnosed with diabetes. The findings suggest that PPI use may be associated with hypomagnesemia. In other words, magnesium levels in diabetic patients using PPIs were observed to tend to be lower compared to those not using PPIs.