This trial has now closed.

PERMIT (Pilot Effectiveness of Randomised Mandatory Insulin Therapy) study to investigate safety and mechanisms of this therapy in reducing mortality in critically ill patients.

The PERMIT study is a single centre pilot randomised controlled trial (n=120) to assess the safety of mandatory insulin infusion in critically ill patients compared with conventional 'as required' insulin infusions, and to examine mechanisms by which this treatment might alter mortality in a longitudinal study. This study will form the basis of a much larger multi-centre study powered to show a clinically significant reduction in ICU mortality.

There are three main reasons why this study should be undertaken:

• Firstly, it is important to determine whether insulin or the condition 'euglycaemia' is the biological effector that alters outcome to inform and plan future research.
• Secondly, euglycaemia in the absence of additional insulin may be ineffective in reducing mortality and so the routine adoption of 'tight' glycaemic control, as is happening at present, will be largely ineffectively.
• Finally, the safety of mandatory insulin infusions needs to be determined.

Patients that are admitted to the Adult Intensive Care Unit at the John Radcliffe and likely to remain in the Unit for more than 5 days will be approached to enter the study.

This project has been funded by the Royal College of Anaesthetists and the British Journal of Anaesthesia.

ISRCTN 00550641

Trial Coordinator Dr V S Barber Kadoorie Centre for Critical Care Research and Education Level 3 The John Radcliffe Hospital Headley Way Headington OXFORD OX3 9DU

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