Endocrine Abstracts

Introduction

Type 2 diabetes and hyperlipidemia are primarily managed with lifestyle modifications, self-monitoring of blood glucose, and medication. Patients who are obese and cannot achieve normal blood glucose levels despite diet, exercise, and multiple medications may be considered for bariatric surgery. Many diabetic patients with very high triglyceride levels are at high risk for ASCVD and therefore after triglyceride levels are controlled the patient should be evaluated for cardiovascular disease risk. Bariatric surgery is more effective at inducing weight loss than either diet or medications. Baratric surgrey is alsow associated more robust decrease in serum triglyceride levels and increase in HDL-C levels. Here we describe a bariatric surgery results of obese multidrug hypersensitive patient with a high level of serum triglyceride.

Case

44 years old woman, had Type-2 Diabetes Mellitus and hyperlipidemia for at least 3 years. She had no medication due to multidrug hypersensitive. Her BMI was 39.9, fasting glucose, serum triglyceride, VLDL, HDL, HbA1C are: 166 mg/dl, 2166 mg/dl, 433 mg/dl, 32 mg/dl, 60 mmol/mol respectively. İn addition to Initial treatment of very low-fat diet, we immediately started medication to reduce triglyceride levels into a safe range to prevent triglyceride-induced pancreatitis. After 10 day of receiving fenofibrate and dapagloflozin she had an generalized acute urticaria need hospitalization and first treated with antihistamine drugs. Here serum triglyceride level was 1906 that force us to continue medication tratment with antihistamine drug. After 4 mounth of treatment and weight loss (10 kg) we didn’t reach therapy goals of hyperlipidemıa. The patient had a bariatric surgrey after mutidisplanary consensur. After surgrey she stoped medication and her serum triglyceride measure was 240 mg/dl.

Conclusion

We report a case of generalized urticaria probable or very probable induced by fenofibrate underwent bariatric surgery. Approximately 60-70%of patients with obesity are dyslipidemic. The Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy have been shown to improve A1C, reduce weight, and reduce the number of medications patients need for diabetes management. Comorbidities such as hyperlipidemia and hypertension also may improve. A reduction in medication of hypersensitive patients can be considered an additional benefit of bariatric surgery.