Eruptive Xanthomas

A 34-year-old man with poorly controlled type 2 diabetes mellitus (HbA1c 12.4%) presents with a 3-week eruption of multiple small, firm, yellow-orange papules on extensor surfaces of elbows, knees, and buttocks. Serum triglycerides are 4,800 mg/dL, and skin biopsy confirms eruptive xanthomas with lipid-laden foamy macrophages. He has a history of recent pancreatitis. The management strategy marked **A** in the diagram — fibrates combined with dietary triglyceride control — is the most appropriate long-term approach because it addresses which of the following pathophysiologic mechanisms?