Evaluation of the Relationship Between Retinopathy and Serum Magnesium Levels in Patients with Type 2 Diabetes Mellitus

Evaluation of the Relationship Between Retinopathy and Serum Magnesium Levels in Patients with Type 2 Diabetes Mellitus | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of the Relationship Between Retinopathy and Serum Magnesium Levels in Patients with Type 2 Diabetes Mellitus İsmail Sefa Aslan, Melike Mercan Baspinar, Elif Ertan, Okcan Basat This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4956540/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: Diabetic retinopathy, a severe complication of Type 2 Diabetes Mellitus, can lead to vision loss and blindness. Magnesium, a vital intracellular cation, plays a key role in insulin and glycaemic regulation. This study investigates the relationship between serum magnesium levels and diabetic retinopathy in T2DM patients. Methods: A total of 118 patients who visited the Family Medicine Clinic of a tertiary hospital, were included in the study. Routine diabetes follow-up examinations and tests (blood pressure measurement, complete blood count, blood biochemistry, electrolytes, HbA1c, cholesterol panel, urinalysis, urine protein/creatinine ratio) were conducted. Retinopathy presence was determined through ophthalmologist consultations, identifying proliferative and non-proliferative diabetic retinopathy. Results: The mean age of patients was 57.1 (10.3) years, with an average diabetes duration of 5.8 ( 4.2) years. Hypomagnesemia was observed in 19.49% of patients. Proliferative retinopathy was present in 7.63%, and non-proliferative retinopathy rate was 15.25%. Diabetes regulation status was well in 59.32%, moderate in 27.97%, and poor in 12.71% of cases. HbA1c values were significantly higher in those with hypomagnesemia (8.73±1.69) compared to those with normal magnesium levels (7.59±1.57) (p<0.05). There was a significant link between retinopathy and T2DM regulation status (p=0.009) and between hypomagnesemia and retinopathy (p<0.001). Retinopathy was found in 43.48% of patients with magnesium deficiency compared to 14.74% without it. Proliferative retinopathy risk increased 6.3 times, and non-proliferative retinopathy risk increased 5.8 times with hypomagnesemia. Conclusion: The risk of developing retinopathy in patients with Type 2 DM increases with magnesium deficiency, and glycemic control is linked to both magnesium deficiency and retinopathy presence. It is concluded that magnesium supplementation may reduce the risk of retinopathy in DM patients with hypomagnesemia. “This study has been presented as an oral abstract in 17th Family Medicine Autumn School, 20-24 September 2023, Concorde Congress Center, Bafra, Cyprus.” Diabetes Magnesium Retinopathy 1. Introduction In 2017, an estimated 451 million people aged 18 to 99 had diabetes globally, with this number projected to rise to 693 million by 2045. Nearly half (49.7%) of these cases are undiagnosed [ 1 ]. Proliferative diabetic retinopathy (DR), a severe diabetes complication, is the leading cause of blindness in working-age adults. Current DR screenings often miss the disease until irreversible damage occurs. Proliferative DR stems from exacerbated DR due to small vessel disease and neuroretinal changes, leading to cell damage, inflammation, neovascularization, and reduced vision. It also predicts other severe diabetic complications like ischemic stroke, creating a "domino effect" in diabetes progression [ 2 ]. The global prevalence of DR has been detected at 22.27% and has different rates: 35.90% in Africa, 33.30% in North America and the Caribbean and 13.37% in South and Central America [ 3 ]. As life expectancy continues to rise and the prevalence of diabetes increases, the prevalence of DR is expected to rise alongside [ 3 ]. Observations in Caucasian diabetics have linked hypomagnesemia as being an additional risk factor for the development of DR, but this correlation is not observed in black African diabetics [ 4 ]. Magnesium (Mg) is the fourth most abundant cation in the human body, and hypomagnesemia is common in patients with type 2 diabetes mellitus (T2DM), particularly those with poor metabolic control. Lower serum magnesium levels correlate with higher HbA1c levels in T2DM patients. Increasing dietary magnesium intake can improve HOMA-IR scores and elevate serum magnesium levels in individuals with T2DM [ 5 ]. Magnesium deficiency is common in diabetic patients, 25–39% of diabetics have low serum magnesium concentrations, compared to rates ranging from 2.5–18% in the normal population [ 6 , 7 ]. Primary care is essential for managing chronic diseases in the health system, with extensive lab facilities, including magnesium testing. Although retinopathy cannot be directly assessed in primary care, its risk factors can be mitigated. This study aimed to determine the relationship between retinopathy and serum magnesium deficiency in patients with type 2 diabetes mellitus. 2. Methods 2.1. Study Design In this single-center, cross-sectional study conducted between October 30, 2021, and December 30, 2021, T2DM patients aged 18 years and older were included. Written informed consent was obtained from each participant. All fundus examinations were conducted by the same ophthalmologist with the patient's consent. Sociodemographic data (age, education, marriage, occupation), anthropometric measurements (height, weight, and body mass index), general health status (arterial blood pressure, DM disease duration, additional disease such as hypertension, drug use list), and laboratory assessments included complete fasting blood glucose, blood count, blood biochemistry, electrolytes, glycated hemoglobin (HbA1C HPLC), cholesterol panel, urinalysis, and urine protein/creatinine ratio were collected through face-to-face interviews using a custom-designed Patient Information Form. A sample of about 5 mL of venous blood was taken after 12 h of fasting. A urine sample of about 10 mL was collected from the patients. The samples were run in a fully automated clinical chemical analyzer. 2.2. Study Sample Size The prevalence of diabetic retinopathy in Type 2 Diabetes Mellitus (T2DM) was considered to be 28.5% in accordance with the literature [ 8 ], and the average number of patients visiting the clinic over two months was taken as 800. Using a two-sided Type 1 (alpha) error of 5% and a power (1-beta) of 80%, the analysis determined that at least 114 patients should be included in the study for diabetic retinopathy screening. 2.3. Patient selection and data collection Patients under the age of 18, pregnant women, breastfeeding women, those with a history of sepsis, those who did not volunteer to participate in the study, those using drugs that may affect magnesium levels (Aminoglycan, Amphotericin B, Cetuximab, Cyclosporine, Digoxin, Diuretics), those with acute or chronic diarrhoea/malabsorption, those taking magnesium-containing supplements and those having a history of eye surgery were not included. Magnesium levels below 1.7 mg/dL are considered hypomagnesemia. All had normal serum creatinine concentrations (below 1.2 mg/dL for men, 1.1 mg/dL for women) and none had other diseases or received drugs known to interfere with mineral metabolism. 2.4. Statistical Analysis SPSS (Statistical Package for Social Sciences for Windows, Armonk, NY, IBM Corp) 22.0 program was used in the analysis. The Kolmogorov-Smirnov test, skewness, and kurtosis values were applied to evaluate the normality of the data distribution. Continuous variables were summarized using mean, median, minimum, maximum, and standard deviations, whereas categorical variables were reported as frequencies and percentages. Logistic regression analysis identified independent risk factors for retinopathy in patients with T2DM. For all statistical tests, a P value < 0.05 was a significant difference level. 3. Results Interrelations between magnesium and glucose metabolism were studied in 118 diabetic outpatients aged 57.1 (10.3) years who applied to family medicine clinics. Prevalence of hypomagnesemia was observed among 23 participants out of 118 (19.5%). The frequency of retinopathy was 22.9% (n = 27), of which 7.6% (n = 9) were proliferative retinopathy and 15.3% (n = 18) were nonproliferative retinopathy. Table 1 compares sociodemographic characteristics, diabetes medications, diabetes regulation status, and retinopathy between the groups with normal Mg levels and hypomagnesemia. The rate of insulin use and the frequency of hypertension comorbidities were higher in the group with hypomagnesemia than in the group with normal Mg levels (p = 0.004; p = 0.035, respectively). In the group with normal Mg levels, patients with the HbA1c level below 6% and the well-regulation rate were higher than that of the hypomagnesemia group (p = 0.015; p = 0.006, respectively). Proliferative or non-proliferative retinopathy was observed more frequently in the hypomagnesemia group than in the group with normal Mg levels (p < 0.001). Table 1 Comparison of sociodemographic characteristics, diabetes medications, diabetes regulation status, and presence of retinopathy between normal and deficient groups Variables Groups with normal and hypomagnesemia levels Normal Hypomagnesemia X 2 P value n (% ) n (% ) Diabetes Medications Oral Antidiabetic Drugs (OAD) 65 ( 68.42) 8 ( 34.78) 8.881 0.004* OAD + Insulin 30 ( 31.58) 15 ( 65.22) Hypertension No 54 ( 56.84) 7 ( 30.43) 5.171 0.035* Yes 41 ( 43.16) 16 ( 69.57) Marital Status Single 18 ( 18.95) 10 ( 43.48) 6.157 0.017* Married 77 ( 81.05) 13 ( 56.52) Education Level Primary Education 64 ( 67.37) 19 ( 82.61) 2.061 0.205 More than high school 31 ( 32.63) 4 ( 17.39) Occupation Unemployed 59 ( 62.11) 19 ( 82.61) 3.474 0.085 Employed 36 ( 37.89) 4 ( 17.39) Body Mass Index (BMI) < 18.5 1 ( 1.05) 1 ( 4.35) 1.622 0.673 18.5–24.9 36 ( 37.89) 8 ( 34.78) 25-29.9 36 ( 37.89) 10 ( 43.48) ≥ 30 22 ( 23.16) 4 ( 17.39) HbA1c (%) < 6 17 ( 17.89) 1 ( 4.35) 10.184 0.015* 6-7.9 46 ( 48.42) 6 ( 26.09) 8–10 22 ( 23.16) 11 ( 47.83) ≥ 10 10 ( 10.53) 5 ( 21.74) DM Regulation Status Good 63 ( 66.32) 7 ( 30.43) 9.879 0.006* Moderate 22 ( 23.16) 11 ( 47.83) Poor 10 ( 10.53) 5 ( 21.74) Retinopathy No Retinopathy 81 ( 85.26) 10 ( 43.48) 21.272 < 0.001* Proliferative Retinopathy 3 ( 3.16) 6 ( 26.09) Non-Proliferative Retinopathy 11 ( 11.58) 7 ( 30.43) *significant p < 0.05 Insert Table 1 here Table 2 compares age, disease duration, anthropometric measurements, and laboratory test results between groups with normal Mg levels and groups with hypomagnesemia. The age and duration of T2DM disease in the group with hypomagnesemia were higher than the others (p = 0.009; p = 0.003, respectively). Fasting blood glucose, HbA1c and Thyroid-Stimulating Hormone (TSH) levels were higher in the group with hypomagnesemia than those without (p = 0.003; p = 0.003; p = 0.016, respectively). Table 2 Comparison of age, disease duration, anthropometric measurements, and laboratory test results between groups with normal Mg level and groups with hypomagnesemia Groups with normal and low magnesium levels Normal Hypomagnesemia t/U p mean ± SD mean ± SD Age 55.93 ± 10.02 62.17 ± 10.17 t=-2.675 0.009* Duration of Diabetes 5.24 ± 3.91 8.09 ± 4.76 t=-2.997 0.003* BMI (Body Mass Index) 26.83 ± 5.14 26.76 ± 7.43 U = 1078.0 0.922 Systolic Blood Pressure 130.79 ± 10.7 135.22 ± 8.98 t=-1.833 0.069 Diastolic Blood Pressure 82.16 ± 5.24 82.83 ± 4.22 t=-0.568 0.571 Fasting blood glucose 154.66 ± 50.35 191.04 ± 52.85 t=-3.080 0.003* HbA1c 7.59 ± 1.57 8.73 ± 1.69 t=-3.062 0.003* Sodium (Na) 140.05 ± 2.06 139.57 ± 2.06 U = 1002.0 0.532 Potassium (K) 4.4 ± 0.48 4.51 ± 0.58 t=-0.926 0.356 Calcium (Ca) 9.39 ± 0.47 9.24 ± 0.53 t = 1.319 0.190 LDL (Low-Density Lipoprotein) 107.08 ± 36.02 99.78 ± 37.93 t = 0.863 0.390 HDL (High-Density Lipoprotein) 48.15 ± 14.81 43.87 ± 6.25 U = 843.0 0.090 Triglycerides (TG) 231.81 ± 202.91 195.83 ± 82.61 U = 953.5 0.345 Total Cholesterol 199.63 ± 39.02 187.13 ± 37.26 t = 1.39 0.167 Glomerular Filtration Rate (GFR) 91.84 ± 17.4 85.04 ± 19.36 t = 1.645 0.103 Protein/Creatinine Ratio 127.07 ± 54.76 176.35 ± 136.58 U = 844.5 0.092 Thyroid-Stimulating Hormone (TSH) 2.19 ± 1.59 3.31 ± 2.59 U = 737.5 0.016* Thyroxine (T4) 11.61 ± 3.72 10.52 ± 3.07 U = 1043.0 0.737 Alanine Aminotransferase (ALT) 23.14 ± 12.31 22.96 ± 10.78 U = 1092.0 0.997 Aspartate Aminotransferase (AST) 22.72 ± 11.93 22.74 ± 10.43 U = 1071.0 0.884 Urea 30.15 ± 10.81 33.91 ± 10.83 t=-1.498 0.137 Creatinine 0.85 ± 0.22 1.03 ± 0.76 U = 951.0 0.336 *significant p < 0.05 Insert Table 2 Table 3 compares groups with proliferative or non-proliferative retinopathy and without retinopathy. The proliferative retinopathy group showed higher age, diastolic blood pressure, fasting blood glucose, HbA1c, and Protein/Creatinine Ratio levels than the non-retinopathy group ( p = 0.015, p = 0.020, p = 0.019, p = 0.035, p = 0.024, respectively). The mean Mg and glomerular filtration rate (GFR) levels in the group without retinopathy were higher than in the non-proliferative retinopathy group (p = 0.018; p = 0.007, respectively). Table 3 Comparison of groups with proliferative retinopathy or non-proliferative retinopathy and without retinopathy Groups Groups with and without retinopathy a No Retinopathy b Proliferative Retinopathy c Non-Proliferative Retinopathy F/X 2 p mean ± SD mean ± SD mean ± SD Age 55.88 ± 10.23 65.78 ± 9.81 59.22 ± 8.93 F = 4.455 0.014* p ab =0.015* Duration of Diabetes 5.34 ± 4.01 8.22 ± 4.35 6.89 ± 4.80 F = 2.695 0.072 BMI (Body Mass Index) 26.61 ± 4.86 30.53 ± 8.64 26.01 ± 7.02 X 2 = 0.890 0.641 Systolic Blood Pressure 130.77 ± 10.95 139.44 ± 7.26 132.22 ± 7.90 F = 2.919 0.058 Diastolic Blood Pressure 81.98 ± 5.21 86.67 ± 4.33 81.67 ± 3.43 F = 3.874 0.024* p ab =0.020* p bc =0.038* Fasting blood glucose 153.6 ± 49.44 202.22 ± 39.91 182.72 ± 60.80 F = 5.583 0.005* p ab =0.019 HbA1c 7.55 ± 1.48 8.94 ± 1.46 8.58 ± 2.08 F = 5.665 0.005* p ab =0.035* p ac =0.034* Sodium (Na) 140.09 ± 2.09 140.11 ± 1.76 139.22 ± 2.05 X 2 = 1.642 0.440 Potassium (K) 4.41 ± 0.49 4.54 ± 0.56 4.46 ± 0.55 F = 0.327 0.722 Calcium (Ca) 9.41 ± 0.46 9.10 ± 0.49 9.22 ± 0.52 F = 2.745 0.068 Magnesium (Mg) 1.88 ± 0.20 1.72 ± 0.21 1.73 ± 0.26 X 2 = 13.636 0.001* p ac =0.018* LDL (Low-Density Lipoprotein) 108.99 ± 34.48 95.44 ± 46.01 93.91 ± 39.28 F = 1.697 0.188 HDL (High-Density Lipoprotein) 46.63 ± 13.52 48.56 ± 17.47 50.17 ± 12.63 X 2 = 2.157 0.340 Triglycerides (TG) 234.93 ± 207.08 243.22 ± 71.61 164.33 ± 62.13 X 2 = 9.345 0.009* p ac =0.025* p bc =0.039* Total Cholesterol 201.49 ± 37.09 192.78 ± 40.95 177.67 ± 42.43 F = 2.988 0.054 Glomerular Filtration Rate (GFR) 92.49 ± 16.76 73.78 ± 23.84 88.89 ± 16.81 F = 4.856 0.009* p ab =0.007* Protein/Creatinine Ratio 125.43 ± 54.97 189.33 ± 92.08 167.19 ± 142.29 X 2 = 6.235 0.044* p ab =0.024* *significant p < 0.05 Insert Table 3 here Table 4 presents a logistic regression analysis of factors increasing the hypomagnesemia in diabetes patients. The presence of proliferative retinopathy increased 6.3 times (odds ratio (OR) = 6.286, 95% Confidence Interval (CI) = 1.067–37.016), and non-proliferative retinopathy increased 5.8 times (OR = 5.778, 95% CI = 1.477–22.609), in cases of magnesium deficiency. Table 4 Logistic Regression Analysis of Factors Increasing the Hypomagnesemia in Diabetes Patients Variables O.R. 95% CI (lower-upper limits) p Diabetes Medications Oral Antidiabetic Drugs (OAD) 1 - - OAD + Insulin 2.537 0.692–9.296 0.160 Hypertansion No 1 - - Yes 1.051 0.305–3.621 0.937 Marital Status Single 1 - - Married 0.530 0.164–1.710 0.288 Employment Status Unemployed 1 - - Employed 1.265 0.276–5.805 0.762 Income Level Income less than expenses - - 0.536 Income equal to expenses 0.581 0.157–2.150 0.416 Income greater than expenses 0.261 0.020–3.337 0.302 HbA1c < 6 1 - - 6-7.9 1.002 0.096–10.428 0.999 8–10 2.146 0.197–23.403 0.531 ≥ 10 0.919 0.060-14.036 0.951 Retinopathy No Retinopathy - - 0.014* Proliferative Retinopathy 6.286 1.067–37.016 0.042* Non-Proliferative Retinopathy 5.778 1.477–22.609 0.012* *significant p < 0.05 Insert Table 4 here 4. Discussion This present study explored the association between serum magnesium levels and the presence of diabetic retinopathy in patients with T2DM. Findings demonstrated a significant relationship between hypomagnesemia and the presence of diabetic retinopathy (DR). Hypomagnesemia was prevalent in 19.5% of the T2DM patients, while 22.9% exhibited DR. Notably, the likelihood of the presence of proliferative retinopathy was 6.3 times higher, and non-proliferative retinopathy was 5.8 times higher in T2DM patients with hypomagnesemia compared to those with normal magnesium levels. A rapid disease progression and an elevated risk of diabetes complications are observed in patients with hypomagnesemia [ 9 ]. Clinical research shows that T2DM patients with hypomagnesemia have decreased activity of pancreatic β-cells and are more insulin resistant. Additionally, dietary supplementation for these patients enhances glucose metabolism and improves insulin sensitivity [ 9 ]. In Turkey, Mısırlıoğlu et al. reported a hypomagnesemia rate of 34% [ 10 ]. However, there are also different studies, such as the study by Erasmus et al. in Nigeria, in which magnesium levels were not found to be significantly lower in diabetic patients [ 4 ]. In our study, 19.5% of T2DM patients had low serum magnesium levels, which correlated with poor glycemic control, as indicated by HbA1C and fasting blood glucose levels. This finding aligns with a meta-analysis by Ana Kelen Rodrigues et al., which identified a link between glycemic control and low serum magnesium levels [ 11 ]. Similarly, Daya Ram Pokharel et al. in Nepal observed that patients with low serum magnesium had higher HbA1C levels [ 12 ]. Another study found an inverse relationship between serum magnesium levels and glycemic parameters (HbA1C and fasting blood glucose) in T2DM patients [ 13 ]. Kumar et al. also noted that 44% of diabetic patients had hypomagnesemia, which was associated with poor glycemic control and DR.[ 14 ]. Elevated magnesium retention in the elderly indicates a significant subclinical magnesium deficit that routine serum magnesium measurements may not detect. Limited data exist on the relationship between magnesium levels and the duration and severity of diabetes. A 2021 study by Paladiya et al. found that hypomagnesemia was significantly lower in patients with a diabetes duration of more than 10 years compared to those with a duration of less than 10 years [ 15 ]. Moreover, this group exhibited poorer glycemic control, evidenced by higher fasting blood glucose and HbA1c levels. The wide range of reported hypomagnesemia incidence likely results from variations in the definition of hypomagnesemia, magnesium measurement techniques, and patient age heterogeneity related to renal function. In a study by Sjögren et al., muscle and plasma magnesium levels in insulin-dependent diabetes patients were significantly lower compared to the general population and correlated with glycemic control [ 16 ]. In our study, 68.42% of patients without low Mg levels were using only oral antidiabetic drugs (OAD), compared to 34.78% who were using insulin plus oral antidiabetic drugs. These data suggest a potential relationship between glycemic control, insulin use, and magnesium levels. As reported by prior studies, hyperglycemia is a possible factor contributing to DR [ 17 ]. This association may be related to the longer duration of diabetes, a history of poorer glycemic control, and increased complications observed in patients using insulin. The Turkish Ophthalmologic Society's Medical Retina Division found that the prevalence of DR was 30.5% based on results from 14 different centers in the country [ 18 ]. The United Kingdom Prospective Diabetes Study (UKPDS) reported that the prevalence of DR was 37% [ 19 ]. In newly diagnosed Type 2 DM patients, Svah et al. found a retinopathy prevalence of 18%. [ 20 ]. A study by Zhang X et al. in the United States found that DR prevalence was 28.5% [ 8 ]. Our study found DR representing a rate of 22.88%, which is consistent with the literature. In a retrospective cohort study by Voigt M et al. analyzing 17461 consultations of 4513 patients from 1987 to 2014, the prevalence of retinopathy was 1.1% at diagnosis, 6.6% after 0–5 years, 12% after 5–10 years, 24% after 10–15 years, 39.9% after 15–20 years, 52.7% after 20–25 years, 58.7% after 25–30 years, and 63% after more than 30 years of disease duration [ 21 ]. In our study, the ages of patients without DR were 55.88 (10.23) years, those with non-proliferative retinopathy were 59.22 (8.93) years, and those with proliferative retinopathy were 65.78 (9.81) years. Our findings were consistent with those of the literature. In the UKPDS study, patients under tight blood pressure control found a 34% reduction in the risk of DR development over 9 years [ 22 ]. Epidemiological studies have shown that hypertension is a risk factor for DR [ 23 ]. A study by Hans U Janka et al. found a relationship between retinopathy development and particularly high diastolic blood pressure [ 24 ]. Our study also found a significant relationship between high diastolic blood pressure and retinopathy, while no significant relationship was found with systolic blood pressure, supporting this study. ACCORD study found that intensive blood glucose control with a target HbA1c level below 6.0% significantly reduced the progression rate of DR compared to a target HbA1c level of 7.0-7.9% [ 25 ]. A Cochrane review has confirmed these findings. In the CURES study by Pradeepa et al., HbA1C levels were significantly higher in retinopathy patients [ 26 ]. In our study, serum glucose levels and HbA1C were significantly higher in DR patients, consistent with the literature. Meah et al. demonstrated that hypomagnesemia is associated with poorly controlled diabetes and worsening fasting blood glucose levels [ 27 ]. Zhang et al. found that low serum magnesium concentrations are linked to DR and other diabetic complications [ 28 ]. Similarly, our results support the assosiations of hypomagnesemia, presence of DR and poor controlled T2DM. Limitations There are some limitations in this study. First, serum magnesium might not fully reflect intracellular magnesium status. Secondly, while adequate for detecting significant associations, it may still be insufficient to generalize the findings to all T2DM patients. 5. Conclusions The results of this study demonstrate a significant association between serum magnesium levels and DR in patients with T2DM, with those with hypomagnesemia showing a markedly higher likelihood of both proliferative and non-proliferative retinopathy. This reinforces the need for vigilant management of serum magnesium, blood pressure, and glycemic control to prevent and manage diabetic retinopathy in T2DM patients. Declarations Author Contributions The authors declare that: ● All the authors have made substantive contributions to the article and assume full responsibility for its content; ● All those who have contributed substantially to the article have been named authors. Conceptualization, I.S.A., E.E., M.M.B, and O.B.; methodology, I.S.A., M.M.B.; formal analysis, I.S.A., M.M.B, and O.B; investigation, I.S.A., M.M.B.; resources I.S.A.,E.E., M.M.B, and O.B.; data curation, I.S.A., E.E. ; writing—original draft preparation, I.S.A., M.M.B.; writing—review and editing, I.S.A.,E.E., M.M.B, and O.B.; visualization, I.S.A., E.E., M.M.B, and O.B.; supervision, I.S.A., E.E., M.M.B, and O.B.; All authors have read and agreed to publish version Funding This research received no external funding. Institutional Review Board Statement The Clinical Research Ethics Committee of Gaziosmanpaşa Training and Research Hospital accepted the study protocol by date 20.10.2021- No:349. Informed consent Informed consent was obtained from all subjects involved in the study. Data Availability Statement The data presented in this study are available on request from the corresponding author. Acknowledgements Thanks to all the participants in this study. 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Exp Clin Endocrinol Diabetes 126(10):570–576. 10.1055/s-0043-120570 Group UPDS (1998) Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 317(7160):703–713. 10.1136/bmj.317.7160.703 Wat N, Wong RL, Wong IY (2016) Associations between diabetic retinopathy and systemic risk factors. Hong Kong Med J 22(6):589–599. 10.12809/hkmj164869 Janka HU, Warram JH, Rand LI, Krolewski AS (1989) Risk factors for progression of background retinopathy in long-standing IDDM. Diabetes 38(4):460–464. 10.2337/diabetes.38.4.460 Hemmingsen B, Lund SS, Gluud C, Vaag A, Almdal TP, Wetterslev J (2013) Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus. Cochrane Database Syst Rev 1110.1002/14651858.CD008143.pub3 Pradeepa R, Anitha B, Mohan V, Ganesan A, Rema M (2008) Risk factors for diabetic retinopathy in a South Indian type 2 diabetic population-the Chennai Urban Rural Epidemiology Study (CURES) Eye Study 4. Diabet Med 25(5):536–542. 10.1111/j.1464-5491.2008.02423.x Meah A, Susan M, Lokare SM (2023) A study of serum magnesium in type 2 diabetes mellitus and its correlation with glycemic control and diabetic microvascular changes. JCDR 14(12):2757–2765 ISSN: 0975–3583 Zhang Y, Li Q, Xin Y, Lv W, Ge C (2018) Association between serum magnesium and common complications of diabetes mellitus. Technol Health Care 26(3):379–387. 10.3233/THC-174702 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4956540","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":357184729,"identity":"06a3fd31-e338-45c3-a9e2-e75800213ad5","order_by":0,"name":"İsmail Sefa Aslan","email":"","orcid":"","institution":"University of Health Sciences, Gaziosmanpasa Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"İsmail","middleName":"Sefa","lastName":"Aslan","suffix":""},{"id":357184730,"identity":"b1daa540-25eb-4ad9-8bd0-b88aeca01fbb","order_by":1,"name":"Melike Mercan Baspinar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYDCCA0D8wCABxrUBYsbGAwS1JCC0pIG0NBChhQGu5TBcECfgu3068UFCQZqcbnvvww8/d5y3W9t+GGhLjU00Li2S53I3GyQY5BibnTluLNl75nbytjOJQC3H0nIbcGgxOMO7TSLBoCJx2400NgbettvJZgeAWhgbDuPTsv0HUEv9tvvP2Bj/tp1LNjv/kKCWbcAQy0kwu8HGxszbdsDO7AYBWyTP8G4GOizNcNuZNGZp2bZkoF6gLQl4/MJ3hnfjhw9/kuXNjh9j/Pi2zc7e7Hz6wwcfamxwasEAiWCVCcQqBwF7UhSPglEwCkbByAAAGyZn11p63u8AAAAASUVORK5CYII=","orcid":"","institution":"University of Health Sciences, Gaziosmanpasa Training and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"Melike","middleName":"Mercan","lastName":"Baspinar","suffix":""},{"id":357184731,"identity":"126c7edb-4b94-45df-b359-78e4aac4da6f","order_by":2,"name":"Elif Ertan","email":"","orcid":"","institution":"Basaksehir Cam and Sakura City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Elif","middleName":"","lastName":"Ertan","suffix":""},{"id":357184732,"identity":"4364fa9e-dd3d-4a6d-a944-18993b781c35","order_by":3,"name":"Okcan Basat","email":"","orcid":"","institution":"University of Health Sciences, Gaziosmanpasa Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Okcan","middleName":"","lastName":"Basat","suffix":""}],"badges":[],"createdAt":"2024-08-22 08:45:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4956540/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4956540/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66215884,"identity":"b74e73ce-1715-4312-8460-77202fe88e72","added_by":"auto","created_at":"2024-10-08 20:16:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":667659,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4956540/v1/a85f247a-1083-4899-8f3d-cb757f57dbe4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of the Relationship Between Retinopathy and Serum Magnesium Levels in Patients with Type 2 Diabetes Mellitus","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eIn 2017, an estimated 451\u0026nbsp;million people aged 18 to 99 had diabetes globally, with this number projected to rise to 693\u0026nbsp;million by 2045. Nearly half (49.7%) of these cases are undiagnosed [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Proliferative diabetic retinopathy (DR), a severe diabetes complication, is the leading cause of blindness in working-age adults. Current DR screenings often miss the disease until irreversible damage occurs. Proliferative DR stems from exacerbated DR due to small vessel disease and neuroretinal changes, leading to cell damage, inflammation, neovascularization, and reduced vision. It also predicts other severe diabetic complications like ischemic stroke, creating a \"domino effect\" in diabetes progression [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The global prevalence of DR has been detected at 22.27% and has different rates: 35.90% in Africa, 33.30% in North America and the Caribbean and 13.37% in South and Central America [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. As life expectancy continues to rise and the prevalence of diabetes increases, the prevalence of DR is expected to rise alongside [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Observations in Caucasian diabetics have linked hypomagnesemia as being an additional risk factor for the development of DR, but this correlation is not observed in black African diabetics [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMagnesium (Mg) is the fourth most abundant cation in the human body, and hypomagnesemia is common in patients with type 2 diabetes mellitus (T2DM), particularly those with poor metabolic control. Lower serum magnesium levels correlate with higher HbA1c levels in T2DM patients. Increasing dietary magnesium intake can improve HOMA-IR scores and elevate serum magnesium levels in individuals with T2DM [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Magnesium deficiency is common in diabetic patients, 25\u0026ndash;39% of diabetics have low serum magnesium concentrations, compared to rates ranging from 2.5\u0026ndash;18% in the normal population [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrimary care is essential for managing chronic diseases in the health system, with extensive lab facilities, including magnesium testing. Although retinopathy cannot be directly assessed in primary care, its risk factors can be mitigated. This study aimed to determine the relationship between retinopathy and serum magnesium deficiency in patients with type 2 diabetes mellitus.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study Design\u003c/h2\u003e \u003cp\u003eIn this single-center, cross-sectional study conducted between October 30, 2021, and December 30, 2021, T2DM patients aged 18 years and older were included. Written informed consent was obtained from each participant. All fundus examinations were conducted by the same ophthalmologist with the patient's consent. Sociodemographic data (age, education, marriage, occupation), anthropometric measurements (height, weight, and body mass index), general health status (arterial blood pressure, DM disease duration, additional disease such as hypertension, drug use list), and laboratory assessments included complete fasting blood glucose, blood count, blood biochemistry, electrolytes, glycated hemoglobin (HbA1C HPLC), cholesterol panel, urinalysis, and urine protein/creatinine ratio were collected through face-to-face interviews using a custom-designed Patient Information Form. A sample of about 5 mL of venous blood was taken after 12 h of fasting. A urine sample of about 10 mL was collected from the patients. The samples were run in a fully automated clinical chemical analyzer.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Study Sample Size\u003c/h2\u003e \u003cp\u003eThe prevalence of diabetic retinopathy in Type 2 Diabetes Mellitus (T2DM) was considered to be 28.5% in accordance with the literature [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and the average number of patients visiting the clinic over two months was taken as 800. Using a two-sided Type 1 (alpha) error of 5% and a power (1-beta) of 80%, the analysis determined that at least 114 patients should be included in the study for diabetic retinopathy screening.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Patient selection and data collection\u003c/h2\u003e \u003cp\u003ePatients under the age of 18, pregnant women, breastfeeding women, those with a history of sepsis, those who did not volunteer to participate in the study, those using drugs that may affect magnesium levels (Aminoglycan, Amphotericin B, Cetuximab, Cyclosporine, Digoxin, Diuretics), those with acute or chronic diarrhoea/malabsorption, those taking magnesium-containing supplements and those having a history of eye surgery were not included. Magnesium levels below 1.7 mg/dL are considered hypomagnesemia. All had normal serum creatinine concentrations (below 1.2 mg/dL for men, 1.1 mg/dL for women) and none had other diseases or received drugs known to interfere with mineral metabolism.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Statistical Analysis\u003c/h2\u003e \u003cp\u003eSPSS (Statistical Package for Social Sciences for Windows, Armonk, NY, IBM Corp) 22.0 program was used in the analysis. The Kolmogorov-Smirnov test, skewness, and kurtosis values were applied to evaluate the normality of the data distribution. Continuous variables were summarized using mean, median, minimum, maximum, and standard deviations, whereas categorical variables were reported as frequencies and percentages. Logistic regression analysis identified independent risk factors for retinopathy in patients with T2DM. For all statistical tests, a P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was a significant difference level.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eInterrelations between magnesium and glucose metabolism were studied in 118 diabetic outpatients aged 57.1 (10.3) years who applied to family medicine clinics. Prevalence of hypomagnesemia was observed among 23 participants out of 118 (19.5%). The frequency of retinopathy was 22.9% (n\u0026thinsp;=\u0026thinsp;27), of which 7.6% (n\u0026thinsp;=\u0026thinsp;9) were proliferative retinopathy and 15.3% (n\u0026thinsp;=\u0026thinsp;18) were nonproliferative retinopathy.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e compares sociodemographic characteristics, diabetes medications, diabetes regulation status, and retinopathy between the groups with normal Mg levels and hypomagnesemia. The rate of insulin use and the frequency of hypertension comorbidities were higher in the group with hypomagnesemia than in the group with normal Mg levels (p\u0026thinsp;=\u0026thinsp;0.004; p\u0026thinsp;=\u0026thinsp;0.035, respectively). In the group with normal Mg levels, patients with the HbA1c level below 6% and the well-regulation rate were higher than that of the hypomagnesemia group (p\u0026thinsp;=\u0026thinsp;0.015; p\u0026thinsp;=\u0026thinsp;0.006, respectively). Proliferative or non-proliferative retinopathy was observed more frequently in the hypomagnesemia group than in the group with normal Mg levels (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of sociodemographic characteristics, diabetes medications, diabetes regulation status, and presence of retinopathy between normal and deficient groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eGroups with normal and hypomagnesemia levels\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHypomagnesemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (% )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en (% )\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDiabetes Medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral Antidiabetic Drugs (OAD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 ( 68.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 ( 34.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e8.881\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.004*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOAD\u0026thinsp;+\u0026thinsp;Insulin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 ( 31.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 ( 65.22)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 ( 56.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 ( 30.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5.171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.035*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 ( 43.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 ( 69.57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 ( 18.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 ( 43.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.017*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 ( 81.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 ( 56.52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 ( 67.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 ( 82.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 ( 32.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 ( 17.39)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 ( 62.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 ( 82.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.474\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 ( 37.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 ( 17.39)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBody Mass Index (BMI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 ( 1.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 ( 4.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e1.622\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.673\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.5\u0026ndash;24.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 ( 37.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 ( 34.78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25-29.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 ( 37.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 ( 43.48)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 ( 23.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 ( 17.39)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHbA1c (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 ( 17.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 ( 4.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e10.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.015*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6-7.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 ( 48.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 ( 26.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 ( 23.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 ( 47.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 ( 10.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 ( 21.74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDM Regulation Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 ( 66.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 ( 30.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e9.879\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.006*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 ( 23.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 ( 47.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 ( 10.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 ( 21.74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRetinopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Retinopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81 ( 85.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 ( 43.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e21.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProliferative Retinopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 ( 3.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 ( 26.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Proliferative Retinopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 ( 11.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 ( 30.43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e*significant p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cem\u003eInsert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003ehere\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e compares age, disease duration, anthropometric measurements, and laboratory test results between groups with normal Mg levels and groups with hypomagnesemia. The age and duration of T2DM disease in the group with hypomagnesemia were higher than the others (p\u0026thinsp;=\u0026thinsp;0.009; p\u0026thinsp;=\u0026thinsp;0.003, respectively). Fasting blood glucose, HbA1c and Thyroid-Stimulating Hormone (TSH) levels were higher in the group with hypomagnesemia than those without (p\u0026thinsp;=\u0026thinsp;0.003; p\u0026thinsp;=\u0026thinsp;0.003; p\u0026thinsp;=\u0026thinsp;0.016, respectively).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of age, disease duration, anthropometric measurements, and laboratory test results between groups with normal Mg level and groups with hypomagnesemia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eGroups with normal and low magnesium levels\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHypomagnesemia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et/U\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.93\u0026thinsp;\u0026plusmn;\u0026thinsp;10.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.17\u0026thinsp;\u0026plusmn;\u0026thinsp;10.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-2.675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.009*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of Diabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.24\u0026thinsp;\u0026plusmn;\u0026thinsp;3.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.09\u0026thinsp;\u0026plusmn;\u0026thinsp;4.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-2.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (Body Mass Index)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.83\u0026thinsp;\u0026plusmn;\u0026thinsp;5.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.76\u0026thinsp;\u0026plusmn;\u0026thinsp;7.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;1078.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.922\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic Blood Pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130.79\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135.22\u0026thinsp;\u0026plusmn;\u0026thinsp;8.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-1.833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic Blood Pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.16\u0026thinsp;\u0026plusmn;\u0026thinsp;5.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.83\u0026thinsp;\u0026plusmn;\u0026thinsp;4.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-0.568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.571\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFasting blood glucose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154.66\u0026thinsp;\u0026plusmn;\u0026thinsp;50.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e191.04\u0026thinsp;\u0026plusmn;\u0026thinsp;52.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-3.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-3.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium (Na)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139.57\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;1002.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.532\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium (K)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-0.926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcium (Ca)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL (Low-Density Lipoprotein)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107.08\u0026thinsp;\u0026plusmn;\u0026thinsp;36.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.78\u0026thinsp;\u0026plusmn;\u0026thinsp;37.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.863\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.390\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL (High-Density Lipoprotein)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.15\u0026thinsp;\u0026plusmn;\u0026thinsp;14.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.87\u0026thinsp;\u0026plusmn;\u0026thinsp;6.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;843.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriglycerides (TG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e231.81\u0026thinsp;\u0026plusmn;\u0026thinsp;202.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e195.83\u0026thinsp;\u0026plusmn;\u0026thinsp;82.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;953.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.345\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Cholesterol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e199.63\u0026thinsp;\u0026plusmn;\u0026thinsp;39.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e187.13\u0026thinsp;\u0026plusmn;\u0026thinsp;37.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlomerular Filtration Rate (GFR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91.84\u0026thinsp;\u0026plusmn;\u0026thinsp;17.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.04\u0026thinsp;\u0026plusmn;\u0026thinsp;19.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtein/Creatinine Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127.07\u0026thinsp;\u0026plusmn;\u0026thinsp;54.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e176.35\u0026thinsp;\u0026plusmn;\u0026thinsp;136.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;844.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThyroid-Stimulating Hormone (TSH)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.31\u0026thinsp;\u0026plusmn;\u0026thinsp;2.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;737.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.016*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThyroxine (T4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.61\u0026thinsp;\u0026plusmn;\u0026thinsp;3.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.52\u0026thinsp;\u0026plusmn;\u0026thinsp;3.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;1043.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.737\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlanine Aminotransferase (ALT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.14\u0026thinsp;\u0026plusmn;\u0026thinsp;12.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.96\u0026thinsp;\u0026plusmn;\u0026thinsp;10.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;1092.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAspartate Aminotransferase (AST)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.72\u0026thinsp;\u0026plusmn;\u0026thinsp;11.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.74\u0026thinsp;\u0026plusmn;\u0026thinsp;10.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;1071.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.884\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.15\u0026thinsp;\u0026plusmn;\u0026thinsp;10.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.91\u0026thinsp;\u0026plusmn;\u0026thinsp;10.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-1.498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;951.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.336\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e*significant p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cem\u003eInsert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e compares groups with proliferative or non-proliferative retinopathy and without retinopathy. The proliferative retinopathy group showed higher age, diastolic blood pressure, fasting blood glucose, HbA1c, and Protein/Creatinine Ratio levels than the non-retinopathy group ( p\u0026thinsp;=\u0026thinsp;0.015, p\u0026thinsp;=\u0026thinsp;0.020, p\u0026thinsp;=\u0026thinsp;0.019, p\u0026thinsp;=\u0026thinsp;0.035, p\u0026thinsp;=\u0026thinsp;0.024, respectively). The mean Mg and glomerular filtration rate (GFR) levels in the group without retinopathy were higher than in the non-proliferative retinopathy group (p\u0026thinsp;=\u0026thinsp;0.018; p\u0026thinsp;=\u0026thinsp;0.007, respectively).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of groups with proliferative retinopathy or non-proliferative retinopathy and without retinopathy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eGroups with and without retinopathy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003eNo Retinopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003csup\u003eb\u003c/sup\u003eProliferative Retinopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003csup\u003ec\u003c/sup\u003eNon-Proliferative Retinopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eF/X\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.88\u0026thinsp;\u0026plusmn;\u0026thinsp;10.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.78\u0026thinsp;\u0026plusmn;\u0026thinsp;9.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.22\u0026thinsp;\u0026plusmn;\u0026thinsp;8.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;4.455\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.014*\u003c/p\u003e \u003cp\u003ep\u003csup\u003eab\u003c/sup\u003e=0.015*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of Diabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.22\u0026thinsp;\u0026plusmn;\u0026thinsp;4.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.89\u0026thinsp;\u0026plusmn;\u0026thinsp;4.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;2.695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (Body Mass Index)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.61\u0026thinsp;\u0026plusmn;\u0026thinsp;4.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.53\u0026thinsp;\u0026plusmn;\u0026thinsp;8.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.01\u0026thinsp;\u0026plusmn;\u0026thinsp;7.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.641\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic Blood Pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130.77\u0026thinsp;\u0026plusmn;\u0026thinsp;10.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139.44\u0026thinsp;\u0026plusmn;\u0026thinsp;7.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e132.22\u0026thinsp;\u0026plusmn;\u0026thinsp;7.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;2.919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic Blood Pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.98\u0026thinsp;\u0026plusmn;\u0026thinsp;5.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.67\u0026thinsp;\u0026plusmn;\u0026thinsp;4.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;3.874\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.024*\u003c/p\u003e \u003cp\u003ep\u003csup\u003eab\u003c/sup\u003e=0.020* p\u003csup\u003ebc\u003c/sup\u003e=0.038*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFasting blood glucose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e153.6\u0026thinsp;\u0026plusmn;\u0026thinsp;49.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e202.22\u0026thinsp;\u0026plusmn;\u0026thinsp;39.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e182.72\u0026thinsp;\u0026plusmn;\u0026thinsp;60.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;5.583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005*\u003c/p\u003e \u003cp\u003ep\u003csup\u003eab\u003c/sup\u003e=0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;5.665\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005*\u003c/p\u003e \u003cp\u003ep\u003csup\u003eab\u003c/sup\u003e=0.035* p\u003csup\u003eac\u003c/sup\u003e=0.034*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium (Na)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140.09\u0026thinsp;\u0026plusmn;\u0026thinsp;2.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e139.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.642\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.440\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium (K)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcium (Ca)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;2.745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMagnesium (Mg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;13.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003cp\u003ep\u003csup\u003eac\u003c/sup\u003e=0.018*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL (Low-Density Lipoprotein)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108.99\u0026thinsp;\u0026plusmn;\u0026thinsp;34.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95.44\u0026thinsp;\u0026plusmn;\u0026thinsp;46.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.91\u0026thinsp;\u0026plusmn;\u0026thinsp;39.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;1.697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.188\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL (High-Density Lipoprotein)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.63\u0026thinsp;\u0026plusmn;\u0026thinsp;13.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.56\u0026thinsp;\u0026plusmn;\u0026thinsp;17.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.17\u0026thinsp;\u0026plusmn;\u0026thinsp;12.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriglycerides (TG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e234.93\u0026thinsp;\u0026plusmn;\u0026thinsp;207.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e243.22\u0026thinsp;\u0026plusmn;\u0026thinsp;71.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e164.33\u0026thinsp;\u0026plusmn;\u0026thinsp;62.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;9.345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.009*\u003c/p\u003e \u003cp\u003ep\u003csup\u003eac\u003c/sup\u003e=0.025* p\u003csup\u003ebc\u003c/sup\u003e=0.039*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Cholesterol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e201.49\u0026thinsp;\u0026plusmn;\u0026thinsp;37.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e192.78\u0026thinsp;\u0026plusmn;\u0026thinsp;40.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e177.67\u0026thinsp;\u0026plusmn;\u0026thinsp;42.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;2.988\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlomerular Filtration Rate (GFR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92.49\u0026thinsp;\u0026plusmn;\u0026thinsp;16.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.78\u0026thinsp;\u0026plusmn;\u0026thinsp;23.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.89\u0026thinsp;\u0026plusmn;\u0026thinsp;16.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;4.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.009*\u003c/p\u003e \u003cp\u003ep\u003csup\u003eab\u003c/sup\u003e=0.007*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtein/Creatinine Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e125.43\u0026thinsp;\u0026plusmn;\u0026thinsp;54.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e189.33\u0026thinsp;\u0026plusmn;\u0026thinsp;92.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e167.19\u0026thinsp;\u0026plusmn;\u0026thinsp;142.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.044*\u003c/p\u003e \u003cp\u003ep\u003csup\u003eab\u003c/sup\u003e=0.024*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e*significant p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cem\u003eInsert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cem\u003ehere\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents a logistic regression analysis of factors increasing the hypomagnesemia in diabetes patients. The presence of proliferative retinopathy increased 6.3 times (odds ratio (OR)\u0026thinsp;=\u0026thinsp;6.286, 95% Confidence Interval (CI)\u0026thinsp;=\u0026thinsp;1.067\u0026ndash;37.016), and non-proliferative retinopathy increased 5.8 times (OR\u0026thinsp;=\u0026thinsp;5.778, 95% CI\u0026thinsp;=\u0026thinsp;1.477\u0026ndash;22.609), in cases of magnesium deficiency.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic Regression Analysis of Factors Increasing the Hypomagnesemia in Diabetes Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eO.R.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI (lower-upper limits)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDiabetes Medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral Antidiabetic Drugs (OAD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOAD\u0026thinsp;+\u0026thinsp;Insulin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.692\u0026ndash;9.296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHypertansion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.305\u0026ndash;3.621\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.937\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.530\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.164\u0026ndash;1.710\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.288\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEmployment Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.276\u0026ndash;5.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.762\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIncome Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncome less than expenses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.536\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncome equal to expenses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.581\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.157\u0026ndash;2.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.416\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncome greater than expenses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.020\u0026ndash;3.337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.302\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6-7.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.096\u0026ndash;10.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.197\u0026ndash;23.403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.531\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.060-14.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.951\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRetinopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Retinopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.014*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProliferative Retinopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.067\u0026ndash;37.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.042*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Proliferative Retinopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.778\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.477\u0026ndash;22.609\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.012*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e*significant p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cem\u003eInsert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e \u003cem\u003ehere\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis present study explored the association between serum magnesium levels and the presence of diabetic retinopathy in patients with T2DM. Findings demonstrated a significant relationship between hypomagnesemia and the presence of diabetic retinopathy (DR). Hypomagnesemia was prevalent in 19.5% of the T2DM patients, while 22.9% exhibited DR. Notably, the likelihood of the presence of proliferative retinopathy was 6.3 times higher, and non-proliferative retinopathy was 5.8 times higher in T2DM patients with hypomagnesemia compared to those with normal magnesium levels.\u003c/p\u003e \u003cp\u003eA rapid disease progression and an elevated risk of diabetes complications are observed in patients with hypomagnesemia [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Clinical research shows that T2DM patients with hypomagnesemia have decreased activity of pancreatic β-cells and are more insulin resistant. Additionally, dietary supplementation for these patients enhances glucose metabolism and improves insulin sensitivity [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In Turkey, Mısırlıoğlu et al. reported a hypomagnesemia rate of 34% [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, there are also different studies, such as the study by Erasmus et al. in Nigeria, in which magnesium levels were not found to be significantly lower in diabetic patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In our study, 19.5% of T2DM patients had low serum magnesium levels, which correlated with poor glycemic control, as indicated by HbA1C and fasting blood glucose levels. This finding aligns with a meta-analysis by Ana Kelen Rodrigues et al., which identified a link between glycemic control and low serum magnesium levels [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Similarly, Daya Ram Pokharel et al. in Nepal observed that patients with low serum magnesium had higher HbA1C levels [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Another study found an inverse relationship between serum magnesium levels and glycemic parameters (HbA1C and fasting blood glucose) in T2DM patients [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Kumar et al. also noted that 44% of diabetic patients had hypomagnesemia, which was associated with poor glycemic control and DR.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eElevated magnesium retention in the elderly indicates a significant subclinical magnesium deficit that routine serum magnesium measurements may not detect. Limited data exist on the relationship between magnesium levels and the duration and severity of diabetes. A 2021 study by Paladiya et al. found that hypomagnesemia was significantly lower in patients with a diabetes duration of more than 10 years compared to those with a duration of less than 10 years [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Moreover, this group exhibited poorer glycemic control, evidenced by higher fasting blood glucose and HbA1c levels. The wide range of reported hypomagnesemia incidence likely results from variations in the definition of hypomagnesemia, magnesium measurement techniques, and patient age heterogeneity related to renal function.\u003c/p\u003e \u003cp\u003eIn a study by Sj\u0026ouml;gren et al., muscle and plasma magnesium levels in insulin-dependent diabetes patients were significantly lower compared to the general population and correlated with glycemic control [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In our study, 68.42% of patients without low Mg levels were using only oral antidiabetic drugs (OAD), compared to 34.78% who were using insulin plus oral antidiabetic drugs. These data suggest a potential relationship between glycemic control, insulin use, and magnesium levels. As reported by prior studies, hyperglycemia is a possible factor contributing to DR [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This association may be related to the longer duration of diabetes, a history of poorer glycemic control, and increased complications observed in patients using insulin.\u003c/p\u003e \u003cp\u003eThe Turkish Ophthalmologic Society's Medical Retina Division found that the prevalence of DR was 30.5% based on results from 14 different centers in the country [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The United Kingdom Prospective Diabetes Study (UKPDS) reported that the prevalence of DR was 37% [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In newly diagnosed Type 2 DM patients, Svah et al. found a retinopathy prevalence of 18%. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. A study by Zhang X et al. in the United States found that DR prevalence was 28.5% [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Our study found DR representing a rate of 22.88%, which is consistent with the literature.\u003c/p\u003e \u003cp\u003eIn a retrospective cohort study by Voigt M et al. analyzing 17461 consultations of 4513 patients from 1987 to 2014, the prevalence of retinopathy was 1.1% at diagnosis, 6.6% after 0\u0026ndash;5 years, 12% after 5\u0026ndash;10 years, 24% after 10\u0026ndash;15 years, 39.9% after 15\u0026ndash;20 years, 52.7% after 20\u0026ndash;25 years, 58.7% after 25\u0026ndash;30 years, and 63% after more than 30 years of disease duration [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In our study, the ages of patients without DR were 55.88 (10.23) years, those with non-proliferative retinopathy were 59.22 (8.93) years, and those with proliferative retinopathy were 65.78 (9.81) years. Our findings were consistent with those of the literature.\u003c/p\u003e \u003cp\u003eIn the UKPDS study, patients under tight blood pressure control found a 34% reduction in the risk of DR development over 9 years [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Epidemiological studies have shown that hypertension is a risk factor for DR [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. A study by Hans U Janka et al. found a relationship between retinopathy development and particularly high diastolic blood pressure [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Our study also found a significant relationship between high diastolic blood pressure and retinopathy, while no significant relationship was found with systolic blood pressure, supporting this study.\u003c/p\u003e \u003cp\u003eACCORD study found that intensive blood glucose control with a target HbA1c level below 6.0% significantly reduced the progression rate of DR compared to a target HbA1c level of 7.0-7.9% [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. A Cochrane review has confirmed these findings. In the CURES study by Pradeepa et al., HbA1C levels were significantly higher in retinopathy patients [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In our study, serum glucose levels and HbA1C were significantly higher in DR patients, consistent with the literature. Meah et al. demonstrated that hypomagnesemia is associated with poorly controlled diabetes and worsening fasting blood glucose levels [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Zhang et al. found that low serum magnesium concentrations are linked to DR and other diabetic complications [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Similarly, our results support the assosiations of hypomagnesemia, presence of DR and poor controlled T2DM.\u003c/p\u003e \u003cp\u003e \u003cem\u003eLimitations\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThere are some limitations in this study. First, serum magnesium might not fully reflect intracellular magnesium status. Secondly, while adequate for detecting significant associations, it may still be insufficient to generalize the findings to all T2DM patients.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThe results of this study demonstrate a significant association between serum magnesium levels and DR in patients with T2DM, with those with hypomagnesemia showing a markedly higher likelihood of both proliferative and non-proliferative retinopathy. This reinforces the need for vigilant management of serum magnesium, blood pressure, and glycemic control to prevent and manage diabetic retinopathy in T2DM patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contributions\u003c/h2\u003e\n\u003cp\u003eThe authors declare that:\u003c/p\u003e\n\u003cp\u003e● All the authors have made substantive contributions to the article and assume full responsibility for its content;\u003c/p\u003e\n\u003cp\u003e● All those who have contributed substantially to the article have been named authors.\u003c/p\u003e\n\u003cp\u003eConceptualization, I.S.A., E.E., M.M.B, and O.B.; methodology, I.S.A., M.M.B.; formal analysis, I.S.A., M.M.B, and O.B; investigation, I.S.A., M.M.B.; resources I.S.A.,E.E., M.M.B, and O.B.; data curation, I.S.A., E.E. ; writing\u0026mdash;original draft preparation, I.S.A., M.M.B.; writing\u0026mdash;review and editing, I.S.A.,E.E., M.M.B, and O.B.; visualization, I.S.A., E.E., M.M.B, and O.B.; supervision, I.S.A., E.E., M.M.B, and O.B.; All authors have read and agreed to publish version\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003ch2\u003eInstitutional Review Board Statement\u003c/h2\u003e\n\u003cp\u003eThe Clinical Research Ethics Committee of Gaziosmanpaşa Training and Research Hospital accepted the study protocol by date 20.10.2021- No:349.\u003c/p\u003e\n\u003ch2\u003eInformed consent\u003c/h2\u003e\n\u003cp\u003eInformed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003eData Availability Statement\u003c/p\u003e\n\u003cp\u003eThe data presented in this study are available on request from the corresponding author.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eThanks to all the participants in this study.\u003c/p\u003e\n\u003ch2\u003eConflict of interest\u003c/h2\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRowley WR, Bezold C, Arikan Y, Byrne E, Krohe S, Diabetes (2030) : insights from yesterday, today, and future trends. 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Cochrane Database Syst Rev 1110.1002/14651858.CD008143.pub3\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePradeepa R, Anitha B, Mohan V, Ganesan A, Rema M (2008) Risk factors for diabetic retinopathy in a South Indian type 2 diabetic population-the Chennai Urban Rural Epidemiology Study (CURES) Eye Study 4. Diabet Med 25(5):536\u0026ndash;542. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1464-5491.2008.02423.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1464-5491.2008.02423.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeah A, Susan M, Lokare SM (2023) A study of serum magnesium in type 2 diabetes mellitus and its correlation with glycemic control and diabetic microvascular changes. JCDR 14(12):2757\u0026ndash;2765 ISSN: 0975\u0026ndash;3583\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Li Q, Xin Y, Lv W, Ge C (2018) Association between serum magnesium and common complications of diabetes mellitus. Technol Health Care 26(3):379\u0026ndash;387. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3233/THC-174702\u003c/span\u003e\u003cspan address=\"10.3233/THC-174702\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Diabetes, Magnesium, Retinopathy","lastPublishedDoi":"10.21203/rs.3.rs-4956540/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4956540/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eDiabetic retinopathy, a severe complication of Type 2 Diabetes Mellitus, can lead to vision loss and blindness. Magnesium, a vital intracellular cation, plays a key role in insulin and glycaemic regulation. This study investigates the relationship between serum magnesium levels and diabetic retinopathy in T2DM patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A total of 118 patients who visited the Family Medicine Clinic of a tertiary hospital, were included in the study. Routine diabetes follow-up examinations and tests (blood pressure measurement, complete blood count, blood biochemistry, electrolytes, HbA1c, cholesterol panel, urinalysis, urine protein/creatinine ratio) were conducted. Retinopathy presence was determined through ophthalmologist consultations, identifying proliferative and non-proliferative diabetic retinopathy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe mean age of patients was 57.1 (10.3) years, with an average diabetes duration of 5.8 ( 4.2) years. Hypomagnesemia was observed in 19.49% of patients. Proliferative retinopathy was present in 7.63%, and non-proliferative retinopathy rate was 15.25%. Diabetes regulation status was well in 59.32%, moderate in 27.97%, and poor in 12.71% of cases. HbA1c values were significantly higher in those with hypomagnesemia (8.73±1.69) compared to those with normal magnesium levels (7.59±1.57) (p\u0026lt;0.05). There was a significant link between retinopathy and T2DM regulation status (p=0.009) and between hypomagnesemia and retinopathy (p\u0026lt;0.001). Retinopathy was found in 43.48% of patients with magnesium deficiency compared to 14.74% without it. Proliferative retinopathy risk increased 6.3 times, and non-proliferative retinopathy risk increased 5.8 times with hypomagnesemia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe risk of developing retinopathy in patients with Type 2 DM increases with magnesium deficiency, and glycemic control is linked to both magnesium deficiency and retinopathy presence. It is concluded that magnesium supplementation may reduce the risk of retinopathy in DM patients with hypomagnesemia.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“This study has been presented as an oral abstract in 17th Family Medicine Autumn School, 20-24 September 2023, Concorde Congress Center, Bafra, Cyprus.”\u003c/em\u003e\u003c/p\u003e","manuscriptTitle":"Evaluation of the Relationship Between Retinopathy and Serum Magnesium Levels in Patients with Type 2 Diabetes Mellitus","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-23 11:22:24","doi":"10.21203/rs.3.rs-4956540/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c29e79a0-87f1-4a49-b414-cac95a4a82cd","owner":[],"postedDate":"September 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-08T20:08:25+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-23 11:22:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4956540","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4956540","identity":"rs-4956540","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}