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Since the Van den Berghe NEJM article in 2001 there have been over 100 additional research studies on more than 300,000 patients covering such topics as glycemic variability, pediatric populations and the challenges of implementing TGC procedures with the current technologies.

See the links to the right for information on TGC protocols and links to additional resources.

Implementing intensive insulin therapy: development and audit of the Bath insulin protocol

Laver S, Preston S, Turner D, McKinstry C, Padkin A.

Anaesth intensive care.2004 Jun;32(3):311-6

Department of Anaesthesia and Intensive Care, Royal United Hospital, Bath, United Kingdom.



Intensive insulin therapy to control blood glucose has been found to reduce mortality among critically ill patients in a surgical intensive care unit, though a simple prescriptive insulin infusion protocol to achieve this has not been published previously. This study documents the development and routine use of a simple prescriptive intravenous insulin infusion protocol for critically ill patients and compares the results with previous practice. During development the protocol was optimized and practical issues of implementation addressed. The optimized protocol was then used for all ICU admissions, and a prospectively defined retrospective chart audit performed for the first month of use. Results were compared with a similar time period the previous year. In September 2002, 27 admissions were started on the protocol. Blood glucose for the time on the protocol had a median value of 6.2 (IQR 5.9-7.1) mmol/l compared with 9.2 (IQR 8.1-10.2) mmol/l for those on insulin in 2001. Blood glucose for the whole ICU stay for those on the protocol in 2002 had a median value of 6.6 (IQR 6.0-7.4) mmol/l compared with 8.6 (IQR 8.0-9.4) mmol/l in 2001. Blood glucose for all ICU patients in 2002 had a median value of 6.5 (IQR 6.0-7.3) mmol/l compared with 7.2 (IQR 6.3-8.3) mmol/l in 2001. Three blood glucose recordings were less than 2.2 mmol/l in September 2002. This study provides initial effectiveness and safety data for the Bath Insulin Protocol Further audits in a larger patient population are now needed.

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