From the Guidelines
High triglycerides can be an indication of diabetes or prediabetes, though they are not a definitive diagnostic marker on their own, and the most recent guidelines recommend addressing lifestyle factors and considering medical therapy to reduce the risk of pancreatitis and cardiovascular disease 1.
Diagnosis and Management
Elevated triglyceride levels (typically above 150 mg/dL) often occur alongside insulin resistance, which is a key feature of type 2 diabetes. When the body becomes resistant to insulin, it affects how fats are metabolized, leading to increased triglyceride production in the liver and decreased clearance from the bloodstream. This relationship is part of a broader pattern called diabetic dyslipidemia, which also includes low HDL cholesterol and elevated small, dense LDL particles.
Key Recommendations
- For patients with fasting triglyceride levels ≥500 mg/dL, evaluate for secondary causes of hypertriglyceridemia and consider medical therapy to reduce the risk of pancreatitis 1.
- In adults with moderate hypertriglyceridemia (fasting or non–fasting triglycerides 175–499 mg/dL), address and treat lifestyle factors (obesity and metabolic syndrome), secondary factors (diabetes, chronic liver or kidney disease and/or nephrotic syndrome, hypothyroidism), and medications that raise triglycerides 1.
- Consider adding icosapent ethyl to statin therapy in patients with ASCVD and/or diabetes plus at least one other CVD risk factor, and with triglyceride levels 135–499 mg/dL and LDL-C levels 41–100 mg/dL, to reduce ASCVD events 1.
Lifestyle Modifications
Lifestyle modifications such as weight loss, reducing sugar and refined carbohydrate intake, limiting alcohol consumption, increasing physical activity, and possibly medications like statins, fibrates, or omega-3 fatty acids may be recommended to manage triglyceride levels. These interventions can simultaneously improve both triglyceride levels and glucose metabolism.
Additional Testing
If you have high triglycerides, your healthcare provider will likely recommend additional testing, including fasting blood glucose and hemoglobin A1C, to properly assess for diabetes.
From the FDA Drug Label
Diseases contributory to hyperlipidemia, such as hypothyroidism or diabetes mellitus should be looked for and adequately treated. Improving glycemic control in diabetic patients showing fasting chylomicronemia will usually obviate the need for pharmacologic intervention.
High triglycerides can be an indication of diabetes, as diabetes mellitus is a disease that can contribute to hyperlipidemia, including high triglycerides. Therefore, patients with high triglycerides should be evaluated for diabetes and other diseases that may be contributing to their hyperlipidemia. 2
From the Research
High Triglycerides and Diabetes
- High triglycerides are often associated with an increased risk of diabetes, particularly type 2 diabetes 3, 4, 5, 6.
- Studies have shown that elevated triglycerides and low high-density lipoprotein (HDL) cholesterol levels are common in patients with type 2 diabetes and are associated with an increased risk of cardiovascular disease 3, 4, 6.
- The presence of atherogenic dyslipidemia, characterized by high triglycerides and low HDL cholesterol, is a marker of high cardiovascular risk in patients with type 2 diabetes 3, 4.
Triglycerides as a Risk Factor for Diabetes
- Even normal triglyceride levels have been shown to be associated with an increased risk of incident type 2 diabetes in healthy individuals 5.
- A study found that increasing triglyceride levels within the normal range were associated with a continuous increase in type 2 diabetes incidence 5.
- Hypertriglyceridemia is an independent predictor of coronary heart disease (CHD) in patients with type 2 diabetes 6.
Management of High Triglycerides
- Lowering triglycerides has been shown to reduce residual cardiovascular risk in patients with type 2 diabetes, particularly those with high triglycerides and low HDL cholesterol 4.
- Fibrates have been shown to be effective in reducing cardiovascular risk in patients with type 2 diabetes and atherogenic dyslipidemia 3, 4.
- Insulin therapy has been used to manage extreme hypertriglyceridemia, with significant reductions in triglyceride levels observed within 24 hours 7.