Diabetes & Metabolism Journal

Review

Metabolic Risk/Epidemiology
Role of Fenofibrate Use in Dyslipidemia and Related Comorbidities in the Asian Population: A Narrative Review: Chaicharn Deerochanawong, Sin Gon Kim, Yu-Cheng Chang; Diabetes Metab J. 2024;48(2):184-195. Published online January 26, 2024; DOI: https://doi.org/10.4093/dmj.2023.0168

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Abstract PDF Supplementary Material PubReader ePub: Hypertriglyceridemia and decreased high-density lipoprotein cholesterol (HDL-C) persist despite statin therapy, contributing to residual atherosclerotic cardiovascular disease (ASCVD) risk. Asian subjects are metabolically more susceptible to hypertriglyceridemia than other ethnicities. Fenofibrate regulates hypertriglyceridemia, raises HDL-C levels, and is a recommended treatment for dyslipidemia. However, data on fenofibrate use across different Asian regions are limited. This narrative review summarizes the efficacy and safety data of fenofibrate in Asian subjects with dyslipidemia and related comorbidities (diabetes, metabolic syndrome, diabetic retinopathy, and diabetic nephropathy). Long-term fenofibrate use resulted in fewer cardiovascular (CV) events and reduced the composite of heart failure hospitalizations or CV mortality in type 2 diabetes mellitus. Fenofibrate plays a significant role in improving irisin resistance and microalbuminuria, inhibiting inflammatory responses, and reducing retinopathy incidence. Fenofibrate plus statin combination significantly reduced composite CV events risk in patients with metabolic syndrome and demonstrated decreased triglyceride and increased HDL-C levels with an acceptable safety profile in those with high CV or ASCVD risk. Nevertheless, care is necessary with fenofibrate use due to possible hepatic and renal toxicities in vulnerable individuals. Long-term trials and real-world studies are needed to confirm the clinical benefits of fenofibrate in the heterogeneous Asian population with dyslipidemia.

Original Articles

Drug/Regimen
Efficacy and Safety of Omega-3 Fatty Acids in Patients Treated with Statins for Residual Hypertriglyceridemia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial: Ji Eun Jun, In-Kyung Jeong, Jae Myung Yu, Sung Rae Kim, In Kye Lee, Kyung-Ah Han, Sung Hee Choi, Soo-Kyung Kim, Hyeong Kyu Park, Ji-Oh Mok, Yong-ho Lee, Hyuk-Sang Kwon, So Hun Kim, Ho-Cheol Kang, Sang Ah Lee, Chang Beom Lee, Kyung Mook Choi, Sung-Ho Her, Won Yong Shin, Mi-Seung Shin, Hyo-Suk Ahn, Seung Ho Kang, Jin-Man Cho, Sang-Ho Jo, Tae-Joon Cha, Seok Yeon Kim, Kyung Heon Won, Dong-Bin Kim, Jae Hyuk Lee, Moon-Kyu Lee; Diabetes Metab J. 2020;44(1):78-90. Published online June 20, 2019; DOI: https://doi.org/10.4093/dmj.2018.0265

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Abstract PDF Supplementary Material PubReader

Background

Cardiovascular risk remains increased despite optimal low density lipoprotein cholesterol (LDL-C) level induced by intensive statin therapy. Therefore, recent guidelines recommend non-high density lipoprotein cholesterol (non-HDL-C) as a secondary target for preventing cardiovascular events. The aim of this study was to assess the efficacy and tolerability of omega-3 fatty acids (OM3-FAs) in combination with atorvastatin compared to atorvastatin alone in patients with mixed dyslipidemia.

Methods

This randomized, double-blind, placebo-controlled, parallel-group, and phase III multicenter study included adults with fasting triglyceride (TG) levels ≥200 and <500 mg/dL and LDL-C levels <110 mg/dL. Eligible subjects were randomized to ATOMEGA (OM3-FAs 4,000 mg plus atorvastatin calcium 20 mg) or atorvastatin 20 mg plus placebo groups. The primary efficacy endpoints were the percent changes in TG and non-HDL-C levels from baseline at the end of treatment.

Results

After 8 weeks of treatment, the percent changes from baseline in TG (−29.8% vs. 3.6%, P<0.001) and non-HDL-C (−10.1% vs. 4.9%, P<0.001) levels were significantly greater in the ATOMEGA group (n=97) than in the atorvastatin group (n=103). Moreover, the proportion of total subjects reaching TG target of <200 mg/dL in the ATOMEGA group was significantly higher than that in the atorvastatin group (62.9% vs. 22.3%, P<0.001). The incidence of adverse events did not differ between the two groups.

Conclusion

The addition of OM3-FAs to atorvastatin improved TG and non-HDL-C levels to a significant extent compared to atorvastatin alone in subjects with residual hypertriglyceridemia.

Citations

Citations to this article as recorded by

Association Between Omega‐3 Fatty Acid Intake and Dyslipidemia: A Continuous Dose–Response Meta‐Analysis of Randomized Controlled Trials
Tianjiao Wang, Xin Zhang, Na Zhou, Yuxuan Shen, Biao Li, Bingshu E. Chen, Xinzhi Li
Journal of the American Heart Association.2023;[Epub] CrossRef
Nutraceutical support in the prevention and treatment of cardiovascular diseases
E. V. Gracheva, E. A. Starovoytova, E. S. Kulikov, N. A. Kirillova, S. V. Fedosenko, M. A. Balaganskaya, D. V. Kromka
Rational Pharmacotherapy in Cardiology.2023; 19(3): 298. CrossRef
Effect of coadministration of omega-3 fatty acids with glimepiride on glycemic control, lipid profile, irisin, and sirtuin-1 in type 2 diabetes mellitus patients: a randomized controlled trial
Rehab H. Werida, Aalaa Ramzy, Youssri Nassief Ebrahim, Maged Wasfy Helmy
BMC Endocrine Disorders.2023;[Epub] CrossRef
The Effect of Dietary Interventions on Hypertriglyceridemia: From Public Health to Molecular Nutrition Evidence
Karla Paulina Luna-Castillo, Xochitl Citlalli Olivares-Ochoa, Rocío Guadalupe Hernández-Ruiz, Iris Monserrat Llamas-Covarrubias, Saraí Citlalic Rodríguez-Reyes, Alejandra Betancourt-Núñez, Barbara Vizmanos, Erika Martínez-López, José Francisco Muñoz-Valle
Nutrients.2022; 14(5): 1104. CrossRef
The effect of omega-3 fatty acids and its combination with statins on lipid profile in patients with hypertriglyceridemia: A systematic review and meta-analysis of randomized controlled trials
Yunjiao Yang, Wen Deng, Yanmei Wang, Tongyi Li, Yiding Chen, Cong Long, Qing Wen, Yue Wu, Qiu Chen
Frontiers in Nutrition.2022;[Epub] CrossRef
Comparison of the Efficacy and Safety of Atorvastatin 40 mg/ω-3 Fatty Acids 4 g Fixed-dose Combination and Atorvastatin 40 mg Monotherapy in Hypertriglyceridemic Patients who Poorly Respond to Atorvastatin 40 mg Monotherapy: An 8-week, Multicenter, Random
Jong Shin Woo, Soon Jun Hong, Dong Hoon Cha, Kee Sik Kim, Moo Hyun Kim, Jun-Won Lee, Myung Ho Jeong, Jin-Ok Jeong, Jun-Hee Lee, Doo Soo Jeon, Eun Joo Cho, Soon Kil Kim, Jun Kwan, Chang Gyu Park, Hae Young Lee, Taek Jong Hong, Jinho Shin, Ho Joong Youn, Do
Clinical Therapeutics.2021; 43(8): 1419. CrossRef
All-Cause Mortality and Cardiovascular Death between Statins and Omega-3 Supplementation: A Meta-Analysis and Network Meta-Analysis from 55 Randomized Controlled Trials
Jeongseon Kim, Tung Hoang, Ji-Myung Kim, So Young Bu, Jeong-Hwa Choi, Eunju Park, Seung-Min Lee, Eunmi Park, Ji Yeon Min, In Seok Lee, So Young Youn, Jee-Young Yeon
Nutrients.2020; 12(10): 3203. CrossRef

Epidemiology
Dietary Sodium Intake in People with Diabetes in Korea: The Korean National Health and Nutrition Examination Survey for 2008 to 2010: Myung Shin Kang, Chong Hwa Kim, Su Jin Jeong, Tae Sun Park; Diabetes Metab J. 2016;40(4):290-296. Published online June 23, 2016; DOI: https://doi.org/10.4093/dmj.2016.40.4.290

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Abstract PDF PubReader

Background

Diabetics are likely to receive advice from their physicians concerning lifestyle changes. To understand how much sodium is consumed by diabetics in Korea, we compared the average daily sodium intake between diabetics and non-diabetics after controlling for confounding factors.

Methods

We obtained the sodium intake data for 13,957 individuals who participated in the Korean National Health and Nutrition Examination Survey (KNHANES), 2008 to 2010, which consisted of a health interview and behavioral and nutritional surveys. The KNHANES uses a stratified, multistage, probability-sampling design, and weighting adjustments were conducted to represent the entire population.

Results

Our analysis revealed that, overall, diabetics tended to have lower sodium intake (4,910.2 mg) than healthy individuals (5,188.2 mg). However, both diabetic and healthy individuals reported higher sodium intake than is recommended by the World Health Organization (WHO). Stratified subgroup analyses revealed that the sodium intake (4,314.2 mg) among newly diagnosed diabetics was higher among women when compared to patients with known diabetes (3,812.5 mg, P=0.035). Female diabetics with cardiovascular disease had lower average sodium intake compared to those without cardiovascular disease after adjusting for sex, age, body mass index, and total energy intake (P=0.058). Sodium intake among male diabetics with hypercholesterolemia (P=0.011) and female diabetics with hypertriglyceridemia (P=0.067) tended to be higher than that among those who without dyslipidemia.

Conclusion

The average sodium intake of diabetics in Korea was higher than the WHO recommends. Sodium intake in newly diagnosed diabetics was significantly higher than that in non-diabetics and previously diagnosed diabetics among females. Prospective studies are needed to identify the exact sodium intake.

Citations

Citations to this article as recorded by

Salt Intake in Adults with Diabetes and Hypertension: The Longitudinal Study of Adult Health-Brasil Study
Natália Gonçalves Ribeiro, Deborah F. Lelis, Rosane H. Griep, Sandhi M. Barreto, Maria del Carmen B Molina, Maria I. Schmidt, Bruce B. Duncan, Isabela Bensenor, Paulo A. Lotufo, José G. Mill, Marcelo Perim Baldo
Metabolic Syndrome and Related Disorders.2024;[Epub] CrossRef
Effects of different diets on glycemic control among patients with type 2 diabetes: A literature review
Maryam E Al-Adwi, Zinab M Al-Haswsa, Karmen M Alhmmadi, Yasmin A Eissa, Aya Hamdan, Hiba Bawadi, Reema F Tayyem
Nutrition and Health.2023; 29(2): 215. CrossRef
Dietary salt intake predicts future development of metabolic syndrome in the general population
Hiroyuki Takase, Kazusa Hayashi, Fumihiko Kin, Suguru Nakano, Masashi Machii, Shin Takayama, Tomonori Sugiura, Yasuaki Dohi
Hypertension Research.2023; 46(1): 236. CrossRef
High Sodium Intake, as Assessed by Urinary Sodium Excretion, Is Associated with Nonalcoholic Fatty Liver Disease or Sarcopenia
Eugene Han, Mi Kyung Kim, Seung-Soon Im, Hye Soon Kim, Taeg Kyu Kwon, Byoung Kuk Jang
Gut and Liver.2023; 17(3): 456. CrossRef
Trends of Dietary Intakes and Metabolic Diseases in Japanese Adults: Assessment of National Health Promotion Policy and National Health and Nutrition Survey 1995–2019
Muhammad Fauzi, Indri Kartiko-Sari, Hemant Poudyal
Journal of Clinical Medicine.2022; 11(9): 2350. CrossRef
Determinants of Type 2 Diabetes Mellitus Among Adults in Dill-Chora Referral Hospital, Dire Dawa, East Ethiopia
Tewodros Getnet Amera, Yibekal Manaye Tefera, Tameru Menberu, Aminu Mohammed Yassin
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2022; Volume 15: 3565. CrossRef
Dietary sodium and cardiovascular morbidity/mortality: a brief commentary on the ‘J-shape hypothesis’
Christiana Tsirimiagkou, Kalliopi Karatzi, Antonios Argyris, Eirini D. Basdeki, Panagiota Kaloudi, Mary Yannakoulia, Athanase D. Protogerou
Journal of Hypertension.2021; 39(12): 2335. CrossRef
Associations of Dietary Salt and Its Sources with Hemoglobin A1c in Patients with Type 2 Diabetes Not Taking Anti-Diabetic Medications: Analysis Based on 6-Month Intervention with a Moderate Low-Carbohydrate Diet
Hajime Haimoto, Takashi Murase, Shiho Watanabe, Keiko Maeda, Kenji Wakai
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2021; Volume 14: 4569. CrossRef
Association of rheumatoid arthritis and high sodium intake with major adverse cardiovascular events: a cross-sectional study from the seventh Korean National Health and Nutrition Examination Survey
Jeong-Hyeon Bae, Min-Young Shin, Eun Ha Kang, Yun Jong Lee, You-Jung Ha
BMJ Open.2021; 11(12): e056255. CrossRef
Nineteen-year trends in fermented food consumption and sodium intake from fermented foods for Korean adults from 1998 to 2016
Sang Young Kim, Jeanne H Freeland-Graves, Hyun Ja Kim
Public Health Nutrition.2020; 23(3): 515. CrossRef
Dietary Sodium Intake and Health Indicators: A Systematic Review of Published Literature between January 2015 and December 2019
Katherine J Overwyk, Zerleen S Quader, Joyce Maalouf, Marlana Bates, Jacqui Webster, Mary G George, Robert K Merritt, Mary E Cogswell
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Lower Leg Fat Depots Are Associated with Albuminuria Independently of Obesity, Insulin Resistance, and Metabolic Syndrome (Korea National Health and Nutrition Examination Surveys 2008 to 2011)
Eugene Han, Nan Hee Cho, Mi Kyung Kim, Hye Soon Kim
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Factors Predicting Sodium Intake of Korean Americans with Type 2 Diabetes
Jisook Ko, Kim B. Kim, Gayle M. Timmerman, Angela P. Clark, Miyong Kim
Journal of Immigrant and Minority Health.2018; 20(3): 641. CrossRef
Evaluation of the association between the number of natural teeth and anemia among Korean adults using nationally representative data
Kyungdo Han, Jun‐Beom Park
Journal of Periodontology.2018; 89(10): 1184. CrossRef
Clinical implications of age and sex in the prevalence of periodontitis in Korean adults with diabetes
Kyungdo Han, Jun‑Beom Park
Experimental and Therapeutic Medicine.2018;[Epub] CrossRef
Association between underweight and tooth loss among Korean adults
In-Seok Song, Kyungdo Han, Jae-Jun Ryu, Jun-Beom Park
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Salt-sensitive genes and their relation to obesity
Yong-Pil Cheon, Myoungsook Lee
Journal of Nutrition and Health.2017; 50(3): 217. CrossRef

Brief Report

Beneficial Effects of Omega-3 Fatty Acids on Low Density Lipoprotein Particle Size in Patients with Type 2 Diabetes Already under Statin Therapy: Myung Won Lee, Jeong Kyung Park, Jae Won Hong, Kwang Joon Kim, Dong Yeob Shin, Chul Woo Ahn, Young Duk Song, Hong Keun Cho, Seok Won Park, Eun Jig Lee; Diabetes Metab J. 2013;37(3):207-211. Published online June 14, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.3.207

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Abstract PDF PubReader

Beyond statin therapy for reducing low density lipoprotein cholesterol (LDL-C), additional therapeutic strategies are required to achieve more optimal reduction in cardiovascular risk among diabetic patients with dyslipidemia. To evaluate the effects and the safety of combined treatment with omega-3 fatty acids and statin in dyslipidemic patients with type 2 diabetes, we conducted a randomized, open-label study in Korea. Patients with persistent hypertriglyceridemia (≥200 mg/dL) while taking statin for at least 6 weeks were eligible. Fifty-one patients were randomized to receive either omega-3 fatty acid 4, 2 g, or no drug for 8 weeks while continuing statin therapy. After 8 weeks of treatment, the mean percentage change of low density lipoprotein (LDL) particle size and triglyceride (TG) level was greater in patients who were prescribed 4 g of omega-3 fatty acid with statin than in patients receiving statin monotherapy (2.8%±3.1% vs. 2.3%±3.6%, P=0.024; -41.0%±24.1% vs. -24.2%±31.9%, P=0.049). Coadministration of omega-3 fatty acids with statin increased LDL particle size and decreased TG level in dyslipidemic patients with type 2 diabetes. The therapy was well tolerated without significant adverse effects.

Citations

Citations to this article as recorded by

Diabetic cardiac autonomic neuropathy: insulin resistance, lipid profile, and omega-3 polyunsaturated fatty acids
Martin-Yurii Markevich, Volodymyr Segin, Victoria Serhiyenko, Alexandr Serhiyenko
InterConf.2023; (35(163)): 213. CrossRef
Atherogenic features of the fatty acid profile of erythrocyte membranes of patients with fatty liver disease of mixed genesis
M. V. Kruchinina, A. V. Belkovets, M. V. Parulikova, A. A. Gromov
Ateroscleroz.2023; 19(4): 350. CrossRef
Omega-3 supplementation in the treatment of polycystic ovary syndrome (PCOS) – a review of clinical trials and cohort
Vitoria Melo, Thomas Silva, Thaissa Silva, Juliana Freitas, Joselita Sacramento, Mirian Vazquez, Edilene Araujo
Endocrine Regulations.2022; 56(1): 66. CrossRef
Nutrigenetics, omega-3 and plasma lipids/lipoproteins/apolipoproteins with evidence evaluation using the GRADE approach: a systematic review
Justine Keathley, Véronique Garneau, Valérie Marcil, David M Mutch, Julie Robitaille, Iwona Rudkowska, Gabriela Magdalena Sofian, Sophie Desroches, Marie-Claude Vohl
BMJ Open.2022; 12(2): e054417. CrossRef
N-3 fatty acid supplementation mediates lipid profile, including small dense LDL, when combined with statins: a randomized double blind placebo controlled trial
Gediz Dogay Us, Sohail Mushtaq
Lipids in Health and Disease.2022;[Epub] CrossRef
The effect of omega-3 fatty acids and its combination with statins on lipid profile in patients with hypertriglyceridemia: A systematic review and meta-analysis of randomized controlled trials
Yunjiao Yang, Wen Deng, Yanmei Wang, Tongyi Li, Yiding Chen, Cong Long, Qing Wen, Yue Wu, Qiu Chen
Frontiers in Nutrition.2022;[Epub] CrossRef
Study of the Healthy Effects of Different Fat Ratios Mixtures of Omega-3 to Omega-6 in Male Mice with Alloxan-Induced Diabetes
Ali. M. Atallah, Faryal. F. Hussein
Tikrit journal for agricultural sciences.2021; 21(4): 129. CrossRef
Omega-3 Fatty Acids as Druggable Therapeutics for Neurodegenerative Disorders
Neha M. Chitre, Nader H. Moniri, Kevin S. Murnane
CNS & Neurological Disorders - Drug Targets.2020; 18(10): 735. CrossRef
Efficacy and Safety of Omega-3 Fatty Acids in Patients Treated with Statins for Residual Hypertriglyceridemia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial
Ji Eun Jun, In-Kyung Jeong, Jae Myung Yu, Sung Rae Kim, In Kye Lee, Kyung-Ah Han, Sung Hee Choi, Soo-Kyung Kim, Hyeong Kyu Park, Ji-Oh Mok, Yong-ho Lee, Hyuk-Sang Kwon, So Hun Kim, Ho-Cheol Kang, Sang Ah Lee, Chang Beom Lee, Kyung Mook Choi, Sung-Ho Her,
Diabetes & Metabolism Journal.2020; 44(1): 78. CrossRef
The combination of canagliflozin and omega-3 fatty acid ameliorates insulin resistance and cardiac biomarkersviamodulation of inflammatory cytokines in type 2 diabetic rats
Mohammed Mohsen Safhi, Tarique Anwer, Gyas Khan, Rahimullah Siddiqui, Sivagurunathan Moni Sivakumar, Mohammad Firoz Alam
The Korean Journal of Physiology & Pharmacology.2018; 22(5): 493. CrossRef
Effect of diets rich in either saturated fat or n-6 polyunsaturated fatty acids and supplemented with long-chain n-3 polyunsaturated fatty acids on plasma lipoprotein profiles
C B Dias, N Amigo, L G Wood, X Correig, M L Garg
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Effects of 12-week supplementation of marine Omega-3 PUFA-based formulation Omega3Q10 in older adults with prehypertension and/or elevated blood cholesterol
Tian Shen, Guoqiang Xing, Jingfen Zhu, Shuxian Zhang, Yong Cai, Donghua Li, Gang Xu, Evan Xing, Jianyu Rao, Rong Shi
Lipids in Health and Disease.2017;[Epub] CrossRef
Effects of dietary saturated and n-6 polyunsaturated fatty acids on the incorporation of long-chain n-3 polyunsaturated fatty acids into blood lipids
C B Dias, L G Wood, M L Garg
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Comparative analysis of the efficacy of omega-3 fatty acids for hypertriglyceridaemia management in Korea
H.-S. Kim, H. Kim, Y. J. Jeong, S. J. Yang, S. J. Baik, H. Lee, S.-H. Lee, J. H. Cho, I.-Y. Choi, H. W. Yim, K.-H. Yoon
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Effects of Omega-3 Fatty Acid Supplementation on Diabetic Nephropathy Progression in Patients with Diabetes and Hypertriglyceridemia
Eugene Han, Yujung Yun, Gyuri Kim, Yong-ho Lee, Hye Jin Wang, Byung-Wan Lee, Bong Soo Cha, Beom Seok Kim, Eun Seok Kang, Wolf-Hagen Schunck
PLOS ONE.2016; 11(5): e0154683. CrossRef
The clinical relevance of omega-3 fatty acids in the management of hypertriglyceridemia
James Backes, Deborah Anzalone, Daniel Hilleman, Julia Catini
Lipids in Health and Disease.2016;[Epub] CrossRef
Supercritical fluid extraction of grape seeds: extract chemical composition, antioxidant activity and inhibition of nitrite production in LPS-stimulated Raw 264.7 cells
Concepción Pérez, María Luisa Ruiz del Castillo, Carmen Gil, Gracia Patricia Blanch, Gema Flores
Food & Function.2015; 6(8): 2607. CrossRef
Omega-3 Polyunsaturated Fatty Acids May Attenuate Streptozotocin-Induced Pancreatic β-Cell Death via Autophagy Activation in Fat1 Transgenic Mice
Won-Min Hwang, Dong-Ho Bak, Dong Ho Kim, Ju Young Hong, Seung-Yun Han, Keun-Young Park, Kyu Lim, Dong-Mee Lim, Jae Gu Kang
Endocrinology and Metabolism.2015; 30(4): 569. CrossRef
Long-chain omega-3 fatty acids, fibrates and niacin as therapeutic options in the treatment of hypertriglyceridemia: A review of the literature
Matthew K. Ito
Atherosclerosis.2015; 242(2): 647. CrossRef
Nutraceuticals and dyslipidaemia: Beyond the common therapeutics
Pietro Scicchitano, Matteo Cameli, Maria Maiello, Pietro Amedeo Modesti, Maria Lorenza Muiesan, Salvatore Novo, Pasquale Palmiero, Pier Sergio Saba, Roberto Pedrinelli, Marco Matteo Ciccone
Journal of Functional Foods.2014; 6: 11. CrossRef
The effect of dietary omega-3 polyunsaturated fatty acids on plasma lipids and lipoproteins of C57BL/6 mice is age and sex specific
K.A. Balogun, R.S. Randunu, S.K. Cheema
Prostaglandins, Leukotrienes and Essential Fatty Acids.2014; 91(1-2): 39. CrossRef
Gene-diet interactions with polymorphisms of the MGLL gene on plasma low-density lipoprotein cholesterol and size following an omega-3 polyunsaturated fatty acid supplementation: a clinical trial
Catherine Ouellette, Iwona Rudkowska, Simone Lemieux, Benoit Lamarche, Patrick Couture, Marie-Claude Vohl
Lipids in Health and Disease.2014;[Epub] CrossRef
Saturated fat consumption may not be the main cause of increased blood lipid levels
C.B. Dias, R. Garg, L.G. Wood, M.L. Garg
Medical Hypotheses.2014; 82(2): 187. CrossRef

Randomized Controlled Trial

Effects of Adding omega-3 Fatty Acids to Simvastatin on Lipids, Lipoprotein Size and Subspecies in Type 2 Diabetes Mellitus with Hypertriglyceridemia.: Won Jun Kim, Chang Beom Lee, Cheol Young Park, Se Eun Park, Eun Jung Rhee, Won Young Lee, Ki Won Oh, Sung Woo Park, Dae Jung Kim, Hae Jin Kim, Seung Jin Han, Hong Keum Cho; Korean Diabetes J. 2009;33(6):494-502. Published online December 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.6.494

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Abstract PDF: BACKGROUND
omega-3 fatty acids are known to improve lipid profiles, the distribution of lipoprotein subclasses, and secondary prevention against post-myocardial infarction. Rare reports have emerged of synergistic results of omega-3 fatty acids with simvastatin in cases of type 2 diabetes mellitus with hypertriglyceridemia. The purpose of this study was to determine the combined relationship of omega-3 fatty acids plus simvastatin on lipid, lipoprotein size and the types of subspecies. METHODS: This randomized, multi-center, comparison study evaluated eight weeks of combination therapy (omega-3 fatty acids (Omacor) 4 g/day plus simvastatin 20 mg/day) or monotherapy (simvastatin 20 mg/day) for at least six weeks in 62 diabetic patients. Subjects with a triglyceride concentration of more than 200 mg/dL were eligible for inclusion. RESULTS: No significant differences for omega-3 fatty acids + simvastatin versus simvastatin alone were observed for triglycerides (-22.7% vs. -14.3%, P = 0.292), HDL peak particle size (+2.8% vs. -0.4%, P = 0.076), LDL mean particle size (+0.4% vs -0.1%, P = 0.376) or LDL subspecies types, although the combination therapy showed a tendency toward lower triglycerides, larger HDL, and LDL particle sizes than did the monotherapy. There were no significant differences between the two groups in regard to HDL-C, LDL-C, or HbA1c levels. There were no serious adverse events and no abnormalities in the laboratory values associated with this study. CONCLUSION: omega-3 fatty acids were a safeform of treatment in hypertriglyceridemic patients with type 2 diabetes mellitus. But, regarding efficacy, a much larger sample size and longer-term follow-up may be needed to distinguish between the effects of combination therapy and monotherapy.

Case Reports

Acquired Generalized Lipodystrophy with Severe Insulin Resistant Diabetes Mellitus.: Jung Min Lee, Tae Seo Sohn, Hyun Shik Son; Korean Diabetes J. 2006;30(6):487-491. Published online November 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.6.487

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Abstract PDF: Acquired generalized lipodystrophy is a rare disease, and often follows autoimmune disease, prodromal infection, HIV infection. The clinical characteristics are generalized absence of fat, insulin resistance, diabetes mellitus, absence of ketosis, elevated basal metabolic rate, severe hypertriglyceridemia, and hepatomegaly. Here we experience and report a case of 16-year-old female patient who has clinical features of acquired generalized lipodystrophy with severe insulin resistant diabetes mellitus without any prodromal states.

A Case of Severe Hypertriglyceridemia with Diabetic Ketoacidosis.: Dong Seop Choi, Jeong Heon Oh, Ie Byung Park, Jin Won Kim, Kyung Mook Choi, Yong Hyun Kim, Nan Hee Kim, Sang Jin Kim, Sei Hyun Baik; Korean Diabetes J. 1999;23(5):715-721. Published online January 1, 2001

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Abstract PDF: Severe hypertriglyceridemia exceeding 5.6 mmol/L in diabetic ketoacidosis occasionally occur in patients with type 1 diabetes mellitus. The pattern of dyslipidemia is usually Fredrickson classification type lV. But it also exists in type III and type V. However, extreme triglyceridemia, triglyceride level exceeds 22.6 mmol/L, occur rarely in the modern era of insulin therapy. And the pattern is usually Fredrickson type I. The severe hypertriglyceridemia in diabetic ketoacidosis is mainly due to lipoprotein lipase deficiency, and secondly to insulin deficiency. The severity usually improves with insulin replacement. In patients with extreme hypertriglyceri-demia, serum electrolyte values of the patients are fallaciously low, and it leads to the misinterpretation of biochemical results and to the inappropriate treatment. We reported a case of a 25 years old female patient with diabetic ketoacidosis and extreme hypertriglyceridemia. At admission, the color of her serum was milky, her plasma triglyceride concentration was 144.7 mmol/L (12864 mg/dL), cholesterol was 25.5 mmol/L (982 mg/dl), and HDL-cholesterol was 0.77 mmol/L (40 mg/dL). The biochemical values at admission could not be measured. Empirical therapy was administered with the use of insulin and fluid. After the initial treatment with insulin and fluid, plasma triglyceride declined rapidly and was nearly normal after 72 hours. We also measured fasting blood glucose concentration and lipid profiles from her father and two sisters. Their plasma glucose and lipid profiles were normal.

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