LOGIC-Insulin Algorithm–Guided Versus Nurse-Directed Blood Glucose Control During Critical Illness The LOGIC-1 single-center, randomized, controlled clinical trial

OBJECTIVEdTight 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 algorithmhas been developed to assist nurses in titrating insulin to maintain blood glucose levels at 80–110 mg/dL (normoglycemia) and to avoid severe hypogly-cemia (,40 mg/dL). The objective was to validate clinically LOGIC-Insulin relative to TGC by experienced nurses. RESEARCH DESIGN AND METHODSdThe 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 com-puter 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. RESULTSdBaseline 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-