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Intensive insulin therapy: protocols in use in The Netherlands


Intensive insulin therapy (IIT) reduces mortality and morbidity of critically ill patients [1]. The 'original IIT protocol' as used by the group of van den Berghe (Leuven, Belgium) is a simple text-based protocol aiming for blood glucose values between 4.4 and 6.1 mmol/l. We conducted a postal survey amongst intensive care physicians and nurses in February 2007. As part of this survey, respondents were asked to send in a copy of their protocol on glycemic control (GC).


All Dutch ICUs with ≥ 5 beds available for mechanical ventilation received a questionnaire on GC policies, in particular thresholds for blood glucose values to start insulin, and the targets of GC. Respondents were explicitly asked to send in their GC protocol too, when available.


Of 71 ICUs responding to the questionnaire, 46 (65%) sent in their GC protocol. Formats of the glucose control protocol varied widely, four different types of protocol formats could be recognized: 'flow chart' based (n = 17), 'sliding scales' based (n = 16), 'text' based (n = 7), and 'others' (n = 5). In three ICUs the GC protocol was computer based. In only 11 GC protocols (24%) were blood glucose targets between 4.4 and 6.1 mmol/l. In the majority of GC protocols (87%), the lower target for blood glucose was <4.5 mmol/l; in only one-half of GC protocols (43%), the upper target for blood glucose was <6.1 mmol/l. In four GC protocols, the thresholds for starting insulin were unclear.


There is large variability in the presently used GS protocols in The Netherlands. In only 24% did the GC-protocol targets reflect those of the original IIT protocol as used by van den Berghe.


  1. van den Berghe G, et al.: N Engl J Med. 2001, 345: 1359-1367. 10.1056/NEJMoa011300

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De Graaff, M., Kieft, H., Van der Sluijs, J. et al. Intensive insulin therapy: protocols in use in The Netherlands. Crit Care 12 (Suppl 2), P160 (2008).

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