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

Felicity Thomas, Hamish Tomlinson, Angus Waston, Hamish Borowczyk, Christopher Pretty, Liam Fisk, Jennifer Dickson, Yeong Shiong Chiew, Geoffrey Shaw, J. Geoffrey Chase

Research output: Chapter in Book/Report/Conference proceedingConference PaperOther


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.

Original languageEnglish
Title of host publication19th IFAC World Congress IFAC 2014, Proceedings
EditorsEdward Boje, Xiaohua Xia
PublisherElsevier - International Federation of Automatic Control (IFAC)
Number of pages6
ISBN (Electronic)9783902823625
Publication statusPublished - 2014
Externally publishedYes
EventInternational Federation of Automatic Control World Congress 2014 - Cape Town International Convention Centre, Cape Town, South Africa
Duration: 24 Aug 201429 Aug 2014
Conference number: 19th

Publication series

NameIFAC Proceedings Volumes (IFAC-PapersOnline)
ISSN (Print)1474-6670


ConferenceInternational Federation of Automatic Control World Congress 2014
Abbreviated titleIFAC 2014
Country/TerritorySouth Africa
CityCape Town
Internet address

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