MAGiC DRAGONS: A protocol for accurate glycaemic control in general wards

[en] 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 existing 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 testing of the benefits of glycaemic control for this cohort. This paper presents the development and testing 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. © IFAC.

Disciplines :

Engineering, computing & technology: Multidisciplinary, general & others

Author, co-author :

Thomas, Felicity Louise ; Université de Liège - ULiège > Doct. sc. ingé. & techno. (électr., électro. & inf- paysage)

Tomlinson, H.; Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

Waston, A.; Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

Borowczyk, H.; Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

Pretty, C.; Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

Fisk, L.; Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

Dickson, J.; Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

Chiew, Y. S.; Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

Shaw, G.

Chase, J.G.

Title :

MAGiC DRAGONS: A protocol for accurate glycaemic control in general wards

Publication date :

2014

Event name :

19th IFAC World Congress on International Federation of Automatic Control, IFAC 2014

Event date :

24 August 2014 through 29 August 2014

Audience :

International

Journal title :

IFAC Proceedings Volumes

ISSN :

1474-6670

eISSN :

2589-3653

Publisher :

IFAC Secretariat

Volume :

Pages :

10138-10143

Peer reviewed :

Peer Reviewed verified by ORBi

Funders :

International Federation of Automatic Control

Commentary :

9783902823625

Available on ORBi :

since 10 May 2016

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