Clinical Evidence

Improving Inpatient Glycemic Safety at Temple Health with EndoTool SubQ

Background

Temple Health, a 3-hospital academic system was experiencing high rates of hypoglycemia due to reliance on sliding scale insulin (SSI). To improve safety and align with ADA guidelines, the hospital implemented EndoTool SubQ, a patient-specific insulin dosing software the supports four dosing protocols, including basal-bolus-correction (BBC).

Objective

Evaluate whether EndoTool SubQ improved glycemic control, with a focus on reducing hypoglycemia rates.

Methods

Setting: 146-bed community hospital within Temple Health
Implementation: June 2024
Patients treated: 2,647 total patients over 8 months; 584 patients on BBC protocol
Data Sources: EndoTool client database and Society of Hospital Medicine 2024 benchmarks
Outcomes Measured:
- Hypoglycemia (<70 mg/dL, <40 mg/dL)
- Hyperglycemia (>300 mg/dL)

Results

Hypoglycemia

Outcomes <70 mg/dL
Metric	Pre-EndoTool	EndoTool SubQ
% of patient days <70 mg/dL	4.7%	2.8%
% of patient stays <70 mg/dL	15.7%	7.9%

Outcomes <40 mg/dL
Metric	Pre-EndoTool	EndoTool SubQ
% of patient days <40 mg/dL	0.5%	0.19%
% of patient stays <40 mg/dL	15.9%	0.64%

BBC Protocol Outcomes

Metric	Pre-EndoTool	EndoTool SubQ
Hyperglycemia >300 mg/dL (patient days)	5.5%	3.2%
% of patient days <70 mg/dL	4.7%	3.9%
% of patient days <40 mg/dL	0.5%	0.36%
% of patient stays <70 mg/dL	15.7%	8.1%
% of patient stays <40 mg/dL	1.9%	0.77%

Conclusion

EndoTool SubQ significantly reduced the incidence of severe hypoglycemia across the inpatient population. Even among patients using the full basal-bolus-correction protocol, outcomes remained strong.

The shift from SSI to a structured, patient-specific insulin dosing platform also improved nurse confidence and clinical consistency, underscoring the value of pairing this technology with frontline education.