Hypertriglyceridaemia in diabetes

doi:10.1136/bmj.39043.398738.DE

BMJ 2006;333:1257-1260 (16 December), doi:10.1136/bmj.39043.398738.DE

Practice

Cases in primary care laboratory medicine

Hypertriglyceridaemia in diabetes

W Stuart A Smellie, consultant

¹ Clinical Laboratory, General Hospital, Bishop Auckland DL14 6AD

info@smellie.com

Mild hypertriglyceridaemia is common in diabetes, but patientswith newly presenting or poorly controlled diabetes may havea quantitatively different syndrome of gross hypertriglyceridaemia,which should be treated by optimising glycaemic control beforeuse of lipid lowering drugs

The first 150 words of the full text of this article appear below.

Introduction

Summary points

Diabetes can be associated withmassive hypertriglyceridaemia, with serum triglyceride concentrations $≥$ 100 mmol/l in extreme cases
Severehypertriglyceridaemia represents an extreme of the classic bloodlipid pattern in diabetes. It carries a risk of acute pancreatitis,and will be missed if serum triglycerides are not measured.Lipaemic samples should always prompt measurement of fastingtriglyceride by the laboratory
Diabetes and impaired glucose tolerance are common findingsin patients with hypertriglyceridaemia. Fasting glucose shouldbe measured, and a glucose tolerance test performed if indicated,in hypertriglyceridaemic patients
Hypertriglyceridaemia due to poor diabetic control does notrespond well to lipid lowering agents. Treating the diabetesis the first priority, although many patients will also havean underlying dyslipidaemia
Seriousmetabolic consequences of poor diabetic control are not reflectedin patients' symptoms

Diagnostics lack the robust evidence base availableto other interventional medical practices, but considerableconsensus guidance obtained from observational and intervention. . . [Full text of this article]

Case 1

Case 2

Discussion

Case 1
Case 2

Questions and answers: learning points

Secondary hyperlipidaemia and hypertriglyceridaemia
When shouldI screen for secondary hyperlipidaemia and what investigationsare required?
When should I measure triglyceridesat the same time as I measure cholesterol?
What triglyceride levels are associated witha risk of pancreatitis and require treatment on this basis?

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