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Evaluation of a Fixed-Dose Insulin Protocol for Hypertriglyceridemia-Induced Acute Pancreatitis: A Retrospective
Neden Yacine1, Stephanie Chauv1, Melissa R Peng1
1Department of Pharmacy, Intermountain Medical Center, Murray, Utah, USA.
Objective:
Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is a severe and increasingly common form of pancreatitis requiring prompt triglyceride-lowering therapy. This study aimed to evaluate the safety and effectiveness of a standardized fixed-dose insulin drip protocol option implemented across a healthcare system.
Design:
Multicenter retrospective cohort study.
Patients:
A total of 466 adult patients admitted with HTG-AP between 15 July 2017, and 10 October 2024. Patients were divided into pre-protocol (n = 242) and post-protocol (n = 224) groups based on implementation of the fixed-dose insulin protocol on 10 June 2021.
Measurements:
The primary outcome was intensive care unit (ICU) length of stay. Secondary outcomes included hospital length of stay and time to achieve triglyceride levels < 1000 mg/dL (11.3 mmol/L). Safety outcomes included incidence of hypoglycemia and hypokalemia.
Results:
Baseline demographics were generally similar between groups, with higher rates of a history of diabetes and hyperlipidemia in the post-protocol group. No statistically significant differences were observed in ICU length of stay, hospital length of stay, or time to triglyceride reduction. Mild hypoglycemia was more common post-protocol (36.6% vs. 25.2%, p = 0.008), while rates of severe hypoglycemia and hypokalemia were low and comparable between groups.
Conclusions:
The fixed-dose insulin protocol demonstrated similar clinical outcomes to historical care with an acceptable safety profile. This protocol offers a reproducible and standardized approach to managing HTG-AP in diverse inpatient settings.
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