title: LOGIC-insulin algorithm-guided versus nurse-directed blood glucose control during critical illness: the LOGIC-1 single-center, randomized, controlled clinical trial.
abstract: OBJECTIVE
  Tight blood glucose control (TGC) in critically ill patients is difficult and labor intensive, resulting in poor efficacy of glycemic control and increased hypoglycemia rate. The LOGIC-Insulin computerized algorithm has been developed to assist nurses in titrating insulin to maintain blood glucose levels at 80-110 mg/dL (normoglycemia) and to avoid severe hypoglycemia (<40 mg/dL). The objective was to validate clinically LOGIC-Insulin relative to TGC by experienced nurses.
  
  
  METHODS
  The investigator-initiated LOGIC-1 study was a prospective, parallel-group, randomized, controlled clinical trial in a single tertiary referral center. A heterogeneous mix of 300 critically ill patients were randomized, by concealed computer allocation, to either nurse-directed glycemic control (Nurse-C) or algorithm-guided glycemic control (LOGIC-C). Glycemic penalty index (GPI), a measure that penalizes both hypoglycemic and hyperglycemic deviations from normoglycemia, was the efficacy outcome measure, and incidence of severe hypoglycemia (<40 mg/dL) was the safety outcome measure.
  
  
  RESULTS
  Baseline characteristics of 151 Nurse-C patients and 149 LOGIC-C patients and study times did not differ. The GPI decreased from 12.4 (interquartile range 8.2-18.5) in Nurse-C to 9.8 (6.0-14.5) in LOGIC-C (P < 0.0001). The proportion of study time in target range was 68.6 ± 16.7% for LOGIC-C patients versus 60.1 ± 18.8% for Nurse-C patients (P = 0.00016). The proportion of severe hypoglycemic events was decreased in the LOGIC-C group (Nurse-C 0.13%, LOGIC-C 0%; P = 0.015) but not when considered as a proportion of patients (Nurse-C 3.3%, LOGIC-C 0%; P = 0.060). Sampling interval was 2.2 ± 0.4 h in the LOGIC-C group versus 2.5 ± 0.5 h in the Nurse-C group (P < 0.0001).
  
  
  CONCLUSIONS
  Compared with expert nurses, LOGIC-Insulin improved efficacy of TGC without increasing rate of hypoglycemia.
authors.affiliation: Department of Intensive Care Medicine, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Van Herpe
authors.forename: Dieter
authors.initials: D
authors.lastname: Mesotten
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Wouters
authors.forename: Jeroen
authors.initials: J
authors.lastname: Herbots
authors.forename: Evy
authors.initials: E
authors.lastname: Voets
authors.forename: Jo
authors.initials: J
authors.lastname: Buyens
authors.forename: Bart
authors.initials: B
authors.lastname: De Moor
authors.forename: Greet
authors.initials: G
authors.lastname: Van den Berghe
mesh_terms: D000368:Aged; D000465:Algorithms; D001786:Blood Glucose / Q000187:drug effects*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin