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The choice of fenofibrate as the most appropriate medication for a patient with type 2 diabetes and very high triglycerides is based on its specific effects on lipid metabolism. Fenofibrate is a fibrate drug that primarily works to reduce triglyceride levels while also having a favorable effect on increasing high-density lipoprotein (HDL) levels.

In patients with type 2 diabetes who often experience hypertriglyceridemia, managing triglycerides is crucial due to the associated risk of cardiovascular disease. Fenofibrate is particularly effective in lowering triglycerides, making it a desirable option for this patient population.

Other medications listed have different primary indications, and while they may have some effects on triglyceride levels, they are not as targeted for very high triglycerides. Statins (such as atorvastatin and pitavastatin) primarily work to lower low-density lipoprotein (LDL) cholesterol and may have a modest effect on triglycerides, but their primary role is in managing cholesterol levels. Ezetimibe focuses on reducing cholesterol absorption and does not directly target triglycerides, making it less appropriate for addressing the very high triglycerides specifically noted in this clinical scenario.

Thus, fenofibrate is the most appropriate choice due to its