Evaluation of a Fixed‐Dose Insulin Protocol for Hypertriglyceridemia‐Induced Acute Pancreatitis: A Retrospective Cohort Study

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.