Van Laecke Steven, Nagler Evi Vanessa, Taes Youri, Van Biesen Wim, Peeters Patrick, Vanholder Raymond
Renal Division, Ghent University Hospital, Ghent, Belgium.
Transpl Int. 2014 Sep;27(9):895-902. doi: 10.1111/tri.12287. Epub 2014 Mar 24.
Post-transplantation hypomagnesemia is common and predicts diabetes. Magnesium improves glycemic control in diabetics and insulin sensitivity in insulin resistant subjects. We aimed to assess the effectiveness of oral magnesium for improving glycemic control and insulin sensitivity at 3 months post-transplantation. We conducted a single-center, open-label, randomized parallel group study. We included adults with serum magnesium <1.7 mg/dl within 2 weeks after kidney transplantation. We randomized participants to 450 mg magnesium oxide up to three times daily or no treatment. The primary endpoint was the mean difference in fasting glycemia. Secondary endpoints were the mean difference in area under the curve (AUC) of glucose during an oral glucose tolerance test and insulin resistance measured by Homeostasis Model of Assessment-Insulin Resistance (HOMA-IR). Analyses were on intention-to-treat basis. In patients randomized to magnesium oxide (N = 27) versus no treatment (N = 27), fasting glycemia on average was 11.5 mg/dl lower (95% CI 1.7 to 21.3; P = 0.02). There was no difference between the two groups neither for 2 h AUC, where the mean value was 1164 mg/dl/min (95% CI -1884 to 4284; P = 0.45) lower in the treatment group nor for HOMA-IR. Magnesium supplements modestly improved fasting glycemia without effect on insulin resistance. Higher baseline glycemia among patients in the control group may have driven the positive outcome (ClinicalTrials.gov number: NCT01889576).
移植后低镁血症很常见，且可预测糖尿病。镁可改善糖尿病患者的血糖控制及胰岛素抵抗患者的胰岛素敏感性。我们旨在评估口服镁在移植后3个月改善血糖控制及胰岛素敏感性的有效性。我们开展了一项单中心、开放标签、随机平行组研究。我们纳入了肾移植后2周内血清镁<1.7mg/dl的成年人。我们将参与者随机分为每日最多三次服用450mg氧化镁组或不治疗组。主要终点为空腹血糖的平均差异。次要终点为口服葡萄糖耐量试验期间葡萄糖曲线下面积（AUC）的平均差异以及通过稳态模型评估胰岛素抵抗（HOMA-IR）测量的胰岛素抵抗。分析基于意向性治疗原则。在随机分为氧化镁组（N = 27）与不治疗组（N = 27）的患者中，空腹血糖平均降低11.5mg/dl（95%CI 1.7至21.3；P = 0.02）。两组在2小时AUC方面无差异，治疗组的平均值低1164mg/dl/min（95%CI -1884至4284；P = 0.45），在HOMA-IR方面也无差异。补充镁适度改善了空腹血糖，但对胰岛素抵抗无影响。对照组患者较高的基线血糖水平可能导致了这一阳性结果（ClinicalTrials.gov编号：NCT01889576）。
