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Clinical Evidence
Near Elimination of Severe Hypoglycemia with EndoTool IV Across a 19-Hospital Health System
Objective
To evaluate the impact of EndoTool IV insulin dosing software on reducing severe hypoglycemia (SH) (blood glucose < 40 mg/dL) across 19-hospitals at a prominent health system, including outcomes in patients with renal insufficiency.
Method
This retrospective analysis examined outcomes over a three-year period (January 2023 – December 2025).
- Population: Patients receiving intravenous insulin therapy
- Scale: 17,838 patients; 362,901 blood glucose values analyzed
- Comparison: Historical paper-based insulin protocols
- Primary metric: SH incidence (events ÷ total BG readings)
- Subgroup analysis:
- eGFR < 15 (high-risk)
- eGFR > 60 (standard)
Key Results:
| Outcome | Pre-EndoTool(Paper Protocol) | EndoTool IV | Impact |
|---|---|---|---|
| Severe Hypoglycemia (SH) | 0.23% | 0.005% | 98% reduction |
| Total SH Events | — | 18 | Extremely low incidence |
| DKA Subgroup SH | — | 0.007% | Maintained safety |
| eGFR < 15 (High Risk) | — | 0.007% | Comparable outcomes across reduced renal functions |
| eGFR > 60 | — | 0.005% | |
| Severe Hyperglycemia | — | 0.17% | Maintained blood glucose control |
Additional Findings
- 2,213 hypoglycemic events prevented through proactive carbohydrate recommendations
- Severe hyperglycemia remained low at 0.17%.
- Consistent outcomes across hospital types
- Comparable safety across renal function groups
Conclusion
EndoTool IV utilization resulted in the near-elimination of severe hypoglycemia while maintaining glycemic control across a large health system. Outcomes remained consistent in high-risk populations, supporting the use of patient-specific insulin dosing to improve safety and reduce variability in inpatient care.
References
Authors
Joseph Aloi, MD, Section Chief of Endocrinology and Metabolism, Advocate Health Wake Forest Baptist Hospital, Paul Chidester, MD, FACP, Medical Director for EndoTool, Glooko
Source
American Association of Clinical Endocrinology (AACE) Annual Meeting 2026
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