Origin and therapy for hypertriglyceridaemia in type 2 diabetes

Table 2 Clinical guide for the assessment and treatment of hypertriglyceridaemia in type 2 diabetes

Steps
1	Obtain fasting lipid profile
2	Classify LDL-cholesterol concentration (primary target of therapy)
	< 2.60 mmol/L – optimal
	2.60-3.39 mmol/L – above optimal
	3.40-4.14 mmol/L – borderline high
	4.15-4.90 mmol/L – high
	> 4.90 mmol/L – very high
	Establish therapy:
	LDL-cholesterol > 2.60 mmol/L – initiate dietary and lifestyle modifications
	LDL-cholesterol > 3.40 mmol/L – consider pharmacotherapy simultaneously with dietary and lifestyle modifications
3	Identify presence of atherosclerotic disease
	Clinical coronary heart disease
	Symptomatic carotid artery disease
	Peripheral artery disease
4	Assess:
	Glycaemic control
	Obesity
	Dietary intake (e.g., Fructose, simple sugars, caloric intake)
	Physical activity
	Determine presence of other risk factors:
	Smoking
	Hypertension
	Family history of premature coronary heart disease (i.e,. in first- degree relative, male < 55 years, female < 65 years)
	Low HDL-cholesterol, < 1.0 mmol/L
5	Order of treatment considerations:
	Improve glycaemia (dietary and lifestyle modifications)
	Treat secondary risk factors
	Statins
	Fibrates
	n-3 fatty acids/niacin
6	Treat elevated triglyceride if triglyceride concentrations are > 2.30 mmol/L after LDL-cholesterol concentration target of < 2.60 mmol/L is reached Target non-HDL cholesterol (< 3.40 mmol/L) Triglyceride > 2.30 mmol/L – intensify LDL-lowering therapy or add fibrate Triglyceride > 5.60 mmol/L – very low-fat diet (< 15% of calories from fat), weight management, physical activity and add fibrate

Adapted from the NCEP ATP III guidelines[31]. LDL: Low density lipoprotein; HDL: High density lipoprotein.