Irfan Ahmeti*, Sash Jovanoska Misevska, Xhuliana Mihajlovska, Ivana Mladenovska Stojkoska, Sebajet Ahmeti Jakupi and Dragan Mijakoski
Introduction: High levels of triglycerides (TG) in the serum can cause acute pancreatitis. Contrarily, there is a proven benefit of the rapid decrease of triglycerides. Although the exact mechanism is unknown, a lot of studies showed that lipoprotein lipase stimulated via insulin reduces triglyceride values.
Aim: Our aim of the study is to prove the treatment benefits with fluids and intravenous rapid insulin in patients with type 2 diabetes and their role of decreasing the risk of acute pancreatitis due to high TG (above 5,6 mmol/L/500 mg/dL) and very high TG (above 11.3 mmol/L/1000 mg/dL), as a result of lipoprotein lipase activity.
Patients and methods: this is interventional follow-up study in 40 patients with hypertriglyceridemia, treated with fluids (Glucose 5%) and rapid insulin Aspart in infusion. All patients were hospitalized at admission (T0) at university clinic of endocrinology – Skopje, treated and monitored for the risk of hypoglycemia (T1). Follow up visit (T2) were done in outpatient clinic. Lipid parameters were compared in all three visits.
Results: Out of 40 patients, 15 were women (37.5%) and 25 man (62.5%). The average age was 43 years. Of the total number, 34 patients had T2DM and 85% of them HbA1c>7.5% (av. HbA1c=10.3%). Six patients (15%) had no DM. At reception, the average TG value was 15, 7 mmol/L. Only 3 patients had TG<5,6 mmol/L. Patients were treated on average with 4150 ml of Dx 5% and insulin Aspartfor an average of 79 U. After 3 days, significant TG reduction was observed, (5.49 mmol/L, p<0.001). On follow up for average 9 months, patients were treated with fenofibrate and/ statin therapy (in those with statin therapy the dose was halved), TG reduction of 3.4 mmol/L (p<0.001) was observed in the group.
Conclusion: Rapid decrease of TG values after few days of treatment with fluids and rapid acting insulin Aspart has been observed in patients with high TG values and a risk of acute pancreatitis in type 2 DM patients with a poor glucose regulation and in non DM patients. TG values gradually reduced their value after applying statins and/or fibrates in the therapy.