Severe hypertriglyceridemia in pediatric type 2 diabetes mellitus: a single-center case series

Hypertriglyceridemia (HTG) due to insulin resistance or deficiency is highly prevalent among patients with type 2 diabetes mellitus (T2DM). Nevertheless, severe hypertriglyceridemia (sHTG, triglyceride > 1000 mg/dL or 11.3 mmol/L) occurs infrequently in pediatric T2DM, with the full triad of sHTG, diabetic ketoacidosis (DKA) and acute pancreatitis (AP) being even more rarely documented. This study aimed to report a case series of sHTG in pediatric T2DM at our single center and to explore the complications, management, and prognosis of sHTG. This retrospective study evaluated triglyceride levels in pediatric patients with T2DM hospitalized at our center. Among the 677 pediatric patients enrolled, 304 (44.9%) had HTG, including 16 (2.4%) with sHTG. Compared with patients without sHTG, those with sHTG exhibited higher levels of plasma glucose ( p < 0.001) and glycated hemoglobin ( p = 0.019), along with higher rates of DKA and AP (both p < 0.001). Among those with sHTG, 7 patients presented with both DKA and AP. The average duration of intravenous insulin therapy in patients with sHTG complicated by DKA was 118 h. Plasmapheresis was administered to the 3 patients with the highest triglyceride levels to rapidly lower serum triglyceride. All 16 patients with sHTG treated at our center demonstrated favorable short-term outcomes following aggressive management. Although sHTG was identified in only 2.4% of hospitalized pediatric patients with T2DM, sHTG was associated with the occurrence of DKA and AP. To our knowledge, we present the first case series describing the even rarer triad of sHTG, DKA, and AP in pediatric T2DM. This novel description underscores the necessity of lipid screening in children with T2DM.