Accurate
glycaemic control (AGC) has been shown to be beneficial to the outcomes of critically ill patients. These benefits may also extend to patients in less acute wards, particularly those with existin
g diabetes. However, the clinical demands of an intensive care
glycaemic control protocol are not appropriate for the
general wards where the nurse-to-patient ratio is much lower and patients do not typically have an intravenous line available for insulin delivery. Thus, there is a need for a safe, effective
glycemic control protocol tailored to the needs of
general wards to enable appropriate care for diabetic patients and further testin
g of the benefits of
glycaemic control for this cohort. This paper presents the development and testin
g of such a protocol for
glycaemic control in the
general wards.
The DRAGONS protocol (Dynamic Regulation for Accurate Glycaemic-control Optimising iNsulin Subcutaneously) was designed to use subcutaneous insulin and only require blood glucose (BG) measurements every four hours, while maintaining BG concentrations within the range 4.4-8.0 mmol/L. Virtual trial simulation indicated an expected time in the target band of 73.0%, with < 2% risk of BG < 4.0 mmol/L. In the first patient recruited to the pilot trial, the DRAGONS protocol achieved 46% time in band and no severe hypoglycaemic episodes. This trial has also highlighted the need for careful selection of the insulin injection site to prevent excessively rapid transport to plasma.