Hypomagnesemia is 10-fold more common in individuals with type 2 diabetes (T2D) than in the healthy population. Factors that are involved in this high prevalence are low Mg2+ intake, gut microbiome composition, medication use, and presumably genetics. Hypomagnesemia is associated with insulin resistance, which subsequently increases the risk to develop T2D or deteriorates glycemic control in existing diabetes. Mg2+ supplementation decreases T2D-associated features like dyslipidemia and inflammation, which are important risk factors for cardiovascular disease (CVD). Epidemiological studies have shown an inverse association between serum Mg2+ and the risk of developing heart failure (HF), atrial fibrillation (AF), and microvascular disease in T2D. The potential protective effect of Mg2+ on HF and AF may be explained by reduced oxidative stress, fibrosis, and electrical remodeling in the heart. In microvascular disease, Mg2+ reduces the detrimental effects of hyperglycemia and improves endothelial dysfunction; however, clinical studies assessing the effect of long-term Mg2+ supplementation on CVD incidents are lacking, and gaps remain on how Mg2+ may reduce CVD risk in T2D. Despite the high prevalence of hypomagnesemia in people with T2D, routine screening of Mg2+ deficiency to provide Mg2+ supplementation when needed is not implemented in clinical care as sufficient clinical evidence is lacking. In conclusion, hypomagnesemia is common in people with T2D and is involved both as cause, probably through molecular mechanisms leading to insulin resistance, and as consequence and is prospectively associated with development of HF, AF, and microvascular complications. Whether long-term supplementation of Mg2+ is beneficial, however, remains to be determined.

中文翻译：

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2 型糖尿病的低镁血症和心血管风险。

低镁血症在 2 型糖尿病 (T2D) 患者中的发生率是健康人群的 10 倍。导致这种高患病率的因素包括低 Mg2+ 摄入量、肠道微生物组成、药物使用以及可能的遗传因素。低镁血症与胰岛素抵抗有关，这随后会增加患 T2D 的风险或恶化现有糖尿病的血糖控制。Mg2+ 补充剂可降低血脂异常和炎症等 T2D 相关特征，这些特征是心血管疾病 (CVD) 的重要危险因素。流行病学研究表明，血清 Mg2+ 与 T2D 患者发生心力衰竭 (HF)、心房颤动 (AF) 和微血管疾病的风险呈负相关。Mg2+ 对 HF 和 AF 的潜在保护作用可以通过减少氧化应激来解释，心脏纤维化和电重构。在微血管疾病中，Mg2+ 可降低高血糖的不利影响并改善内皮功能障碍；然而，缺乏评估长期补充 Mg2+ 对 CVD 事件影响的临床研究，并且在 Mg2+ 如何降低 T2D 患者的 CVD 风险方面仍存在差距。尽管 T2D 患者低镁血症的患病率很高，但由于缺乏足够的临床证据，临床护理中并未实施常规筛查 Mg2+ 缺乏症以在需要时提供 Mg2+ 补充。总之，低镁血症在 T2D 患者中很常见，并且可能通过导致胰岛素抵抗的分子机制作为原因，并且可能与 HF、AF 和微血管并发症的发展相关。