Effect of SGLT2 inhibitors on serum magnesium level in diabetic patients with hypomagnesemia and chronic kidney disease

Background: Hypomagnesemia is a frequent electrolyte abnormality observed among individuals with diabetes, particularly those with chronic kidney disease (CKD). Sodium-glucose cotransporter 2 inhibitors (SGLT2) have revealed potential benefits in modifying electrolyte balance, but their impact on serum Mg levels in this patient population remains unclear. This study aimed to assess the impact of SGLT2 inhibitors on serum Mg levels in individuals with diabetes with hypomagnesemia and CKD. Methods: This follow-up observational study was executed at the nephrology clinic of Maadi Military Medical Complex, Cairo, Egypt. A total of 24 diabetic patients with CKD and hypomagnesemia (serum Mg <1.8 mg/dL) were enrolled and initiated on SGLT2 inhibitors. Baseline assessments included clinical examination, detailed medical history, and laboratory investigations such as serum Mg, creatinine, estimated glomerular filtration rate (eGFR), sodium, potassium, and urinary Mg. Serum Mg and fractional excretion of Mg were repeated at one week, and serum Mg was re-evaluated at one-month post-treatment to assess the sustainability of the drug effect. Results: A significant increase in serum Mg levels was documented one week following initiating SGLT2 inhibitors (p<0.05), with sustained levels at the one-month follow-up. Fractional excretion of Mg was significantly reduced, indicating improved Mg retention. Conclusion: SGLT2 inhibitors were effective in increasing serum Mg levels and reducing Mg loss in diabetic individuals with hypomagnesemia and CKD. This effect was sustained over one month, reflecting that SGLT2 inhibitors might influence correcting Mg imbalance in this patient population. Additional investigations with larger cohorts are required to validate these findings.