Evaluating the efficacy of intensified insulin therapy in hypertriglyceridemic acute pancreatitis management: a systematic review and meta-analysis

Abstract

Background Hypertriglyceridemia has long been regarded as a major cause of pancreatitis, and its incidence has been increasing annually. However, the role of intensified insulin therapy in treating hypertriglyceridemic acute pancreatitis (HTG-AP) remains debatable. Methods A prospectively registered meta-analysis (CRD420261344642) was conducted to examine eligible randomized controlled trials (RCTs) or retrospective observational studies (ROSs) through searches across PubMed, Cochrane Library, and Embase databases, as well as the Web of Science, with a search period up to 1st March 2026. Eligible meta-analyses were selected based on predefined criteria. Data analysis was conducted using RevMan (version 5.4) and R (version 4.4.3). Results A total of 12 studies including 1,505 patients were identified that compared the effectiveness of intensive insulin therapy with other treatment modalities in patients with HTG-AP. The results revealed a statistically non-significant difference in triglyceride reduction between intensive insulin therapy and other treatments (intensive insulin therapy versus other therapy: 24hTG, MD: 1.25, 95%CI: −0.53 to 3.03, P = 0.17; 48hTG, MD: 0.07, 95%CI: −0.79 to 0.93, P = 0.88; 72hTG, MD: −0.54, 95%CI: −3.36 to 2.27, P = 0.71. Similarly, triglycerides were not significantly reduced with blood purification therapy (intensive insulin therapy versus blood purification: 24hTG, MD: 1.47, 95%CI: −1.24 to 4.19, P = 0.29; 48hTG, MD: 0.72, 95%CI: −0.69 to 2.13, P = 0.32; 72hTG, MD: 1.89, 95%CI: −2.22 to 6.00, P = 0.37). Additionally, intensive insulin therapy was not associated with a higher incidence of local pancreatic complications or systemic adverse effects. Intensive insulin therapy experienced a significantly reduced duration of hospital stay in comparison to the cohort receiving the blood purification regimen (MD: −3.60, 95%CI: −5.09 to −2.11, P < 0.01). Conclusions Current evidence does not demonstrate the superiority of either intensive insulin therapy or blood purification, but intensive insulin therapy may shorten the length of hospital stay to a certain extent. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261344642, PROSPERO CRD420261344642.