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Very severe hypertriglyceridemia tied to diabetes reveals gaps in care
An analysis of county-level health system data in Texas revealed that uncontrolled diabetes often predicted incidence of very severe hypertriglyceridemia, with an overwhelming number of cases occurring among Hispanic adults, according to findings published in the Journal of the Endocrine Society.
“Our work shows there is a significant population of patients with triglycerides above 2,000 mg/dL within our own county safety-net health care system,” Zahid Ahmad, MD, associate professor of internal medicine at UT Southwestern Medical Center, told Endocrine Today. “Most of these cases are related to uncontrolled type 2 diabetes, and unfortunately, most the patients did not get adequately monitored after the initial measurement of very high triglycerides.”
Using electronic medical records data, Esparza and colleagues assessed all serum lipid measurements in 2016 at Parkland Health and Hospital System, a county hospital providing both inpatient and outpatient care for an indigent population in Dallas. Results were filtered to include patients with very severe hypertriglyceridemia, defined as at least one measurement of triglycerides more than 2,000 mg/dL. For patients with very severe hypertriglyceridemia, researchers performed a retrospective review of data on underlying causes, lipid-lowering therapy and follow-up. Researchers used logistic regression analysis to predict a patient’s acute pancreatic risk using categorized age, race, alcohol status, hypertension status, categorized BMI and categorized triglycerides (< 3,000 mg/dL, 3,000-4,425 mg/dL and 4,425 mg/dL) as independent variables.
Among 95,836 lipid measurements for 71,495 unique patients in 2016, 164 serum triglyceride measurements were at least 2,000 mg/dL for 103 unique patients (32 women; 0.14% of patients). These patients were overwhelmingly Hispanic (79%), and most had diabetes (76%), hypertension (49%) and obesity (51%), according to researchers. Sixty patients with a triglyceride measurement of at least 2,000 mg/dL were admitted to the hospital, among them 39 for acute pancreatitis (87% Hispanic; mean age, 40 years; median serum triglyceride level, 3,003 mg/dL).
Researchers found that the major conditions associated with very severe hypertriglyceridemia were uncontrolled diabetes (n = 78), heavy alcohol use (n = 11), medications (n = 7) and uncontrolled hypothyroidism (n = 2). Many patients had overlapping conditions associated with very severe hypertriglyceridemia, according to researchers.
After the index measurement of at least 2,000 mg/dL, researchers observed that 70% of patients attended a clinic visit for follow-up; however, health care providers addressed the hypertriglyceridemia in only 50% of those visits, whereas serum triglycerides were remeasured in only 18% of patients.
“Although 45% of patients were referred to a specialty lipid clinic, only one-third of referred patients were eventually seen there,” the researchers wrote.
The researchers noted that future efforts should focus on identifying and treating patients with very severe hypertriglyceridemia before they develop acute pancreatitis.
“Since these patients are at high risk of pancreatitis, we need to pay more attention to them,” Ahmad said. “With electronic medical records, we should now be able to quickly identify hypertriglyceridemia patients and make sure to get them in to a specialty lipid clinic as needed.”– by Regina Schaffer
For more information:
Zahid Ahmad, MD, can be reached at UT Southwestern Medical Center, Department of Internal Medicine, Division of Nutrition and Metabolic Diseases, 5323 Harry Hines Blvd., Dallas, TX 75390; email: Zahid.ahmad@utsouthwestern.edu.
Disclosures: Ahmad reports he has given educational talks for Akcea and Amgen.