BACKGROUND Although reduced sweet taste perception has been found in studies of clofibrate in healthy volunteers, this phenomenon has not been reported for the chemically related and more widely used drug fenofibrate. CASE REPORT A 65-year-old woman with insulin-treated type 2 diabetes was initiated on fenofibrate for worsening diabetic retinopathy. She subsequently developed a marked loss of sweet taste perception. After 3 months of fenofibrate, her glycemic control had improved and her insulin requirements had decreased, probably as a result of anorexia. Her renal function had also worsened. Dechallenge resulted in near normalization of sweet taste and restoration of her pretreatment renal function 2 weeks later. Rechallenge provoked recurrence of severely impaired sweet taste perception, which led to permanent discontinuation of fenofibrate. CONCLUSIONS This case shows that altered sweet taste perception is a potential clinically significant adverse effect of fenofibrate therapy. There is increasing interest in the function of sweet taste receptors, which are recognized as having a broader role in cellular function and inflammation in tissues such as the kidney and retina that are relevant to type 2 diabetes and its complications.