diabetes mellitus ( dm ) is an important disease with increasing incidence and strong medical and social impact especially through severe cardiovascular complications . peripheral artery disease ( pad ) of the lower limbs is frequently seen in diabetics and tends to have a more severe evolution . some trace - elements like magnesium ( mg ) and selenium ( se ) have modified values in diabetic patients blood revealing a potential involvement in the appearance of the disease and its complications . we aimed to measure the serum values of mg and se in a group of type 2 diabetics , mean age 58 and with a duration of the disease of approx . 8.5 years , metabolically balanced without specific severe complications or morbid associations ; from those we delimited a group of 64 diabetics which also had pad in the second degree of evolution showing signs of claudication with medium - efforts . we tried to identify some potential relation between clinico - biological data and also possible prognostic and therapeutic relations in these diseases . this was a clinical study related to paraclinical investigations including serum se and mg measurement in type 2 diabetics admitted in a hospital during the last 3 years . the clinical group consisted of 114 type 2 diabetics , mean aged 56.60.5 years having a mean duration of the disease of 14.50.5 years , mostly men ( 80 cases ) with metabolically compensated disease at the moment of investigation . from those we separated a group of 62 diabetics that also had pad in the 2 stage with intermittent claudication of approx . 8020 m. in this group as well the majority were men ( 40 cases ) . a group of 40 healthy individuals ( blood donors ) of similar age were the control group . we obtained the paticipation consent from those included in the study and also the approval from the university ethical comitee . the clinical study included a thorough physical examination , with body weight , blood pressure measurement , pulse taking etc . laboratory investigations included current data hematological and bioclinical ( cholesterol , triglycerides , hdl - cholesterol , glycemia , nitrates , creatinin , glycated hemoglobin etc . ) . they also were subject to ecg , chest xray , retinal exam , microalbuminuria , echo - cardiography examination . investigation of the peripheral arteries was performed by doppler echography of the lower limbs by the same examiner . serum mg was assessed by an automated method in a konelab multianalyser and the serum se was quantified by atomic absorption spectroscopy in the chemistry laboratory of the babes - bolyai university in cluj ( prof . we noted below the serum levels of mg and se in diabetics as compared to controls and those with pad ( see table i ) . compared values of mg in diabetics vs. the control group showed statistically significant differences and also in diabetics vs. the pad group , with a p<0.05 . we also noted severe hypomagnesiemia in diabetics , more intense in the presence of pad of the lower limbs . we state that pad was only of the second degree with a quite stable claudication index . according to gender the values values of serum mg were notably lower in women , also the mean values of serum se were lower in that group . mean values of mg but also se became lower with ageing , with statistical significance ( p<0.01 ) analyzing the duration of the diabetes we had the following data ( p<0.05 ) ( table iv ) . usually the duration of the diabetes was associated with statistically significant low values for mg but also for se . it is know the fact that dm evolves in the presence of dyslipidemia , often severe , which is present in pad and usually associates with mixed dyslipidemia which is a marker but also a pathogenetic element of generalized atherosclerosis . the values for classic lipidic parameters in dm and in dm+pad were associated with the decrease of serum mg and se ( * p<0.01 ) ( table v ) . the dm group we investigated had no severe microvascular or macrovascular complication ( e.g. myocardial infarction ) . despite this fact , paraclinical investigation such as retinal exam , microalbumiuria allowed us to note some early alterations such as diabetic retinopathy and values of microalbuminuria , which correspond to the initial changes found in nephropathy . the presence of these initial changes was related to some mg and se changes . among the type 2 diabetics we studied the presence of retinopathy was seen in approximately 25% of them and 30% had signs of nephropathy , while the dz+pad group had even higher percentage : 40% retinopathy and 50% nephropathy . the long lasting metabolic imbalance was assessed by the levels of hba1c which had lower values in case of severe aggravation ( * p<0.01 , * * p<0.05 ) ( table vi ) . in pad patients the severe and long lasting metabolic imbalance ( hba1c>12% ) vascular ultrasound examination evidenced multiple arterial obstructions that could not be related to the values of mg or se in blood . dm is a metabolic disease with increasing incidence , affecting around 4% of the general population ; diabetes is a disease that leads to micro and macrovascular changes like the frequent pad . mg is a microelement that plays an important role in biology and pathology , being involved in multiple biological and metabolic processes . , then mc nair , paolisso , rayssignier , classen , seelig and others  all of them proving mg deficit in dm , its role and importance being vastly studied [ 18,10,11,17,19,20 ] . there is also a relation between mg values and the duration of dm revealed also by our findings : blood serum mg decreases almost parallel to the duration of disease especially in aging women . our dm+pad group proved to have even lower values for mg ( proved statistically significant ) than the controls or dm group ; basically the pad group had the lowest values of all ; also the mg dropped above 65 years . in romania , interesting data regarding the role and the importance in pathology of the mg were published decades ago by szantay , porr , nechifor , miu and dragatoiu , zeana and others that showed the importance role played by hypomagnesemia in various diseases like dm , digestive illnesses , hbp , cad and others [ 46,8,1417,21,29 ] . also hypomagnesemia correlated often with severe dyslipidemia from pad , in which case its pathogenetic role in the evolution of atherosclerosis may be discussed . long term imbalanced diabetes , proved by very high levels of hba1c correlated with very low mg values . many authors plead for the existing underlying mg deficit in dm , intensified in the presence of pad . the causes of this phenomenon are not fully known yet : it is considered there is also a lower intake , a low absorption or a higher loss of mg possibly by medication like diuretics or malnutrition . our data add up to prove the severe hypomagnesemia in dm , especially complicated with pad with a significant lowering in the presence of microangiopathy . serum se is an essential microelement for antioxidative and immunomodulatory processes , involved in many metabolic processes and defense , being vasoactive and antitumoral . recent data showed low blood se in the onset of hypertension , coronary heart disease but also neoplasia of the liver , colon or prostate . although the importance of dietary supplements of se is vastly discussed the results of prophylaxis of neoplasia are controversial [ 2225,31,32,37,42 ] . our data revealed low values of se in dm , intensely decreased in dm+pad . in various papers the data regarding the se behaviour in various diseases are often contradicting other data but most of those shows a direct relation between serum se and dislypidemia and chd , ami , hbp [ 12,2224,3235,42 ] . our data are close to those results , se values being significantly lower in dm+pad , related to the duration of diabetes , its long metabolic imbalance , dyslipidemia or atherosclerosis . its reduction was more expressed by ageing but also by the duration of the disease . selenium is also involved in the pathogenesis of hbp , systemic atherosclerosis , lots of published works identifying a se deficit when chd or atherosclerosis was present including pad [ 3,2224,31,32,42,43 ] . some authors found almost a parallel between the intensity of the se deficit and the seriousness of chd or hbp ; many works tested the value of some food supplements or drugs containing se without getting significant results . it is already known that se binds to certain proteins and plays a role in attenuating the inflammatory effects besides other antioxidative mechanisms . kok ( 1987 ) noted that very low values of se in blood ( blow 45 on the other hand , other authors noted that very high levels of se also associate with increased cardiovascular mortality . experimental data ( manati  2009 ) noted the protective role of a se supplementation against drug - induced injuries on rabbit liver . our data obtained from the studied group revealed the existence in dm of a se deficit , but even more a mg one , augmented in the presence of pad . presence of pad ( 2 stage ) leads to significant lowering of mg and se , the decreased values progressing with age and duration of the disease . mixed dyslipidemia tends to relate with a decrease of mg and se in dm+pad , suggesting an associated mechanism of aggravation . long - standing metabolic imbalance of dm in pad is associated with low se and mg values . microangiopathy in its early stage tends to relate to low values of mg and se in patients . this significant deficit of mg and se suggests the involvement of these oligoelements in the atherosclerotic process and in the metabolic imbalance of dm , suggesting that a corrective supplementation with mg and se may prove useful in selected cases .
background and aimsknowing that diabetes mellitus ( dm ) often leads to cardiovascular injury such as peripheral artery disease ( pad ) of the lower limbs and that some microelements like magnesium ( mg ) and selenium ( se ) might be involved in the alterations entailed by these complications , we aimed to investigate the behavior of those microelements in these diseases.methodswe studied 114 patients with type 2 dm , treated not with insulin but only by diet or oral antidiabetics , mean aged 56.6 having a mean duration of the diabetes of 14.5 years , mostly men ( 80 ) , 64 of them ( 40 men ) having also pad stage 2 without severe complications . 
 we had a control group of 40 similarly - aged subjects without dm or pad . 
 the measurements were performed on a konelab 30i device and serum selenium was quantified by atomic absorption spectroscopy . 
 all patients underwent clinical , paraclinical and arterial doppler echography for establishing the diagnosis of pad.resultsthe results for controls were 2.20.4 mg / dl for mg , 1306 g / dl for se ; diabetics had 1.680.4 mg / dl mg , 886 g / dl se ; diabetics with pad had significantly lower levels : 1.360.6 mg / dl mg , 666 g / dl se ( p<0.05 ) . 
 age inversely correlated with the values of both microelements especially in women . 
 mixed dysipidemia , present in dm , correlated with pad . 
 blood pressure also inversely correlated with mg and se . 
 coronary heart disease ( ischemia ) linked to lower blood values of mg and se . left ventricle hypertrophy ( as proved by echography ) also correlated to lower blood values of mg and se , as did glycated hemoglobin ( hba1c).conclusionwe may conclude that in dm there is a mg deficit which becomes significant in dz+pad especially in forms with high blood pressure ( hbp ) , severe dyslipidemia and in the presence of early microvascular complications , our paper suggesting the opportunity of a substitutive treatment with mg and se in selected cases .