In reply: How should diabetic dyslipidemia be treated?
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* Ting-I Lee

We agree that statin therapy is first-line treatment for primary prevention of atherosclerotic cardiovascular disease for patients with diabetes mellitus who are 40 to 75 years of age.1 However, severe hypertriglyceridemia (fasting triglycerides ≥ 500 mg/dL and especially > 1,000 mg/dL) in diabetic patients, such as our patient,2 may warrant pharmacologic therapy with fibric acid derivatives, fish oil, or both to reduce the risk of acute pancreatitis.3 Thus, lifestyle modifications, glycemic control with oral hypoglycemic agents, and fenofibrate therapy were initially prescribed to our patient.2

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2.  Hsueh YC, Chou CL, Lee TI. Diabetic dyslipidemia with eruptive xanthoma. Cleve Clin J Med 2019; 86(9):575–576. doi:10.3949/ccjm.86a.18104
    
    [FREE Full Text](http://www.ccjm.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NToiY2Nqb20iO3M6NToicmVzaWQiO3M6ODoiODYvOS81NzUiO3M6NDoiYXRvbSI7czoyMToiL2Njam9tLzg3LzEvMTEuMi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

3.  American Diabetes Association. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes—2019. Diabetes Care 2019; 42(suppl 1):S90–S102. doi:10.2337/dc19S009
    
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