Background <p>Dorzagliatin tablets are most commonly used for the treatment of type 2 diabetes mellitus (T2DM). This case report describes a rare but clinically significant metabolic adverse event.</p> Objective <p>To report a case of severe hypertriglyceridemia, a metabolic adverse event, induced by Dorzagliatin Tablets.</p> Case presentation <p>A 70-year-old female of Han ethnicity with a history of type 2 diabetes mellitus (T2DM) for 18&#xa0;years was admitted for poor glycemic control. Prior to this admission, her hypoglycemic regimen included insulin degludec, metformin, and acarbose. On June 14, 2024, dorzagliatin tablets (75&#xa0;mg, twice daily) were initiated. Ten days later, the patient reported bilateral lower extremity weakness and pain, and her triglyceride (TG) level sharply increased to 21.46&#xa0;mmol/L. Her medical history included hypertension, an ankle fracture, right kidney stones, and endoscopic polypectomy. She had no history of blood transfusion, infection, or any known allergies. Upon physical examination, no abnormalities were noted. Laboratory testing revealed elevated TG, but other routine tests and diabetes-related markers were unremarkable. The patient was advised to stop taking dorzagliatin, and lipid-lowering treatment (fenofibrate and niacin) was initiated, which led to normalization of triglyceride levels in 1&#xa0;week. Serum dorzagliatin concentration could not be measured due to the unavailability of specific assays in our institution, which remains a limitation of this case. Nonetheless, the temporal relationship and Naranjo score supported a probable adverse reaction.</p> Conclusions <p>These findings provide evidence for a possible mechanism and support the rationale for regular lipid profile monitoring during dorzagliatin treatment.</p>