To assess the pathogenesis of chylomicronemia in diabetes mellitus, we have studied 10 diabetic patients with fasting chylomicronemia. Chylomicronemia in diabetes mellitus can be categorized into 2 groups.
Group 1: Four patients without genetic forms of hypertriglyceridemia. When they were treated with insulin, the plasma triglyceride concentrations fell rapidly in a logarithmic manner with a disapperance rate (k) of 1.23±0.72/day. Hyperlipidemia in these patients followed a typical course of diabetic lipemia.
Group 2: Six of the ten patients studied seemed to have a familial form of hyperlipidemia. Plasma triglyceride concentrations in this group also fell in a logarithmic manner (k = 0.16±0.02/day), however, the k values were significantly smaller than those of group 1 patients. The cause of chylomicronemia in group 2 may be attributed to a combination of the following: 1. Excessive food intake and alcohol consumption which increase hepatic VLDL production. 2. Defective removal of triglyceride-rich lipoproteins due to decreased lipoprotein lipase activity.
It is concluded that chylomicronemia developed in diabetes is heterogeneous in its pathogenesis.