Hypertriglyceridaemia in type 2 diabetes: prevalence,risk and primary care management

Cardiovascular disease (CVD) associated with type 2 diabetes will impose an increasing burden on primary care over the next few decades. Several mutually reinforcing factors account for the increased CVD risk among patients with diabetes, including hypertriglyceridaemia, the importance of which has been generally underestimated. A consensus from the literature suggests that fasting triglyceride levels of 1.7 mmol/L or above may be a cause for cardiovascular concern and warrant further investigation. Apart from CVD, hypertriglyceridaemia can increase the risk of pancreatitis. Clinicians in primary care should become active in identifying and managing secondary causes of hypertriglyceridaemia and encourage patients with diabetes to implement lifestyle changes. Statins are the mainstay of treatment for diabetic dyslipidaemia that remains inadequately controlled. However, the National Institute for Health and Clinical Excellence (NICE) suggests prescribing a fibrate if triglyceride levels remain >4.5 mmol/L after addressing secondary causes. Clinicians could consider adding a fibrate if triglyceride levels remain between 2.3 and 4.5 mmol/L despite statin monotherapy for patients at high CVD risk. NICE advocates a trial of highly concentrated, licensed omega-3 fish oils if lifestyle measures and fibrate fail to adequately reduce hypertriglyceridaemia.