TGC-Fast Trial
In a study evaluating the impact of glucose control in ICU patients, participants were randomly divided into two groups: Liberal Glucose Control (initiating insulin only when blood-glucose exceeded 215 mg/dL) and Tight Glucose Control (targeting blood-glucose levels between 80 to 110 mg/dL using the LOGIC-Insulin algorithm). Both groups abstained from parenteral nutrition for one week.
Results showed that the median morning blood-glucose level was 140 mg/dL for the liberal group and 107 mg/dL for the tight control group. Severe hypoglycemia was slightly more prevalent in the tight-control group (1.0%) compared to the liberal group (0.7%). There was no significant difference in the duration of ICU care (P=0.94) or 90-day mortality rates (10.1% for liberal vs. 10.5% for tight; P=0.51) between the two groups.
Secondary outcomes revealed similar findings for both groups, although tight glucose control seemed to have a lower incidence of severe acute kidney injury and cholestatic liver dysfunction. In conclusion, for ICU patients not receiving early parenteral nutrition, tight glucose control didn't significantly influence ICU stay duration or mortality.
Tight Blood-Glucose Control without Early Parenteral Nutrition in the ICU | NEJM