New EndoTool IV Data Presented at AACE Demonstrates Near Elimination of Severe Hypoglycemia Across 19 Hospitals
Glooko, Inc., a globally integrated digital health company dedicated to improving diabetes management and glycemic safety across care settings, has unveiled new clinical evidence demonstrating the effectiveness of its EndoTool IV insulin dosing system. The findings were presented at the American Association of Clinical Endocrinology Annual Meeting and highlight the system’s potential to significantly reduce one of the most dangerous complications associated with inpatient insulin therapy—severe hypoglycemia.
The data stem from a comprehensive three-year retrospective analysis conducted between January 2023 and December 2025. The study evaluated outcomes across a large 19-hospital health system, offering a robust real-world dataset that underscores the scalability and clinical impact of advanced decision-support tools in hospital environments. The analysis encompassed 17,838 patients and incorporated an extensive dataset of 362,901 blood glucose readings, providing a detailed picture of glycemic control under EndoTool IV-guided care.
At the center of the findings is a dramatic reduction in severe hypoglycemia, defined as blood glucose levels below 40 mg/dL. According to the analysis, the incidence of such events dropped to just 0.005%—equivalent to only 18 recorded readings—when using EndoTool IV. This represents a 98% reduction compared to traditional paper-based insulin dosing protocols, which showed a significantly higher incidence rate of 0.23%. These results suggest that transitioning from static, manual systems to dynamic, algorithm-driven approaches can markedly enhance patient safety.
The study findings were detailed in a poster presentation titled “Virtual Elimination of Severe Hypoglycemia Utilizing a Computerized Insulin Dosing Algorithm for Intravenous Insulin Infusions.” The research was led by Joseph Aloi, Section Chief of Endocrinology and Metabolism at Advocate Health Wake Forest Baptist Hospital, alongside Paul Chidester, Medical Director for EndoTool at Glooko. Their work provides compelling evidence supporting the integration of intelligent dosing systems into routine inpatient care.
One of the notable strengths of the analysis is its inclusion of high-risk patient populations, particularly those with complex metabolic conditions. Among 4,804 patients treated using protocols specific to Diabetic Ketoacidosis, a serious and potentially life-threatening complication of diabetes, the incidence of severe hypoglycemia remained extremely low at 0.007%. This finding is particularly significant given the delicate balance required in managing insulin therapy for DKA patients, where both hyperglycemia and hypoglycemia pose substantial risks.
Similarly, the study evaluated outcomes in patients with varying levels of kidney function, an important factor influencing insulin metabolism. In individuals with severe renal impairment—defined as an estimated glomerular filtration rate (eGFR) below 15—the incidence of severe hypoglycemia was 0.007%. This rate is comparable to the 0.005% observed in patients with normal kidney function (eGFR above 60), suggesting that EndoTool IV is capable of maintaining consistent safety outcomes across diverse patient groups, including those traditionally considered more vulnerable.
In addition to minimizing hypoglycemia, the system also demonstrated effectiveness in preventing extreme hyperglycemia, defined as blood glucose levels exceeding 300 mg/dL. The incidence of such events remained low at 0.17%, indicating that tighter glycemic control was achieved without increasing the risk of dangerously low blood sugar levels. This balance between avoiding both extremes is a key challenge in inpatient diabetes management and underscores the value of adaptive dosing strategies.
A particularly innovative aspect of EndoTool IV is its ability to anticipate and prevent hypoglycemic events before they occur. The analysis revealed that the system recommended prophylactic carbohydrate interventions that helped avert an estimated 2,213 potential hypoglycemia episodes. By identifying early warning signs and prompting timely clinical action, the system enhances patient safety while reducing the likelihood of emergency interventions.
Dr. Aloi emphasized the clinical importance of these findings, noting that severe hypoglycemia remains one of the most serious risks in hospital-based insulin management. This risk is especially pronounced in patients with impaired kidney function, where insulin clearance is reduced and the margin for dosing error is narrow. He highlighted that the consistency of the results across a large and diverse patient population strengthens the case for adopting more advanced dosing tools in routine practice.
The effectiveness of EndoTool IV is rooted in its sophisticated, patient-specific dosing model. Unlike traditional protocols that rely on standardized guidelines, the system uses a multivariable algorithm to tailor insulin therapy to individual patient needs. Key factors incorporated into the model include renal function, steroid use and the presence of residual insulin in the body, often referred to as estimated residual extracellular insulin (EREI). This dynamic approach allows clinicians to make more precise dosing decisions, reducing variability and improving outcomes.
The system also includes specialized therapy modes designed for complex inpatient scenarios, such as diabetic ketoacidosis, hyperosmolar hyperglycemic state (HHS) and euglycemic DKA. These conditions require nuanced management strategies, and the ability of EndoTool IV to adapt to these clinical contexts further enhances its utility in hospital settings.
Dr. Chidester highlighted the broader implications of the study, pointing out that improving glycemic safety requires more than simply updating protocols. He argued that hospitals need intelligent decision-support systems that reflect how individual patients respond to insulin therapy in real time. By standardizing care while still allowing for personalization, tools like EndoTool IV can help reduce clinical risk and support frontline healthcare providers in delivering high-quality care.
Beyond clinical outcomes, the adoption of EndoTool IV also appears to deliver operational benefits. The analysis reported a 55% reduction in the number of blood glucose checks required, which can significantly decrease the workload for nursing staff. At the same time, nursing satisfaction increased by 75%, suggesting that the system not only improves patient outcomes but also enhances the overall care experience for healthcare professionals.
These findings are particularly relevant in the current healthcare landscape, where hospitals face increasing pressure to improve performance metrics related to patient safety and quality of care. Severe hypoglycemia and hyperglycemia are key indicators of inpatient care quality, and reducing their incidence is a priority for many health systems. By demonstrating measurable improvements in these areas, EndoTool IV positions itself as a valuable tool for achieving both clinical and operational excellence.
Moreover, the scalability of the system across a 19-hospital network highlights its potential for widespread adoption. As healthcare systems continue to embrace digital transformation, solutions that combine clinical intelligence with real-world usability are likely to play an increasingly important role in shaping the future of care delivery.
In conclusion, the data presented by Glooko provide compelling evidence that advanced, algorithm-driven insulin dosing systems can significantly enhance glycemic safety in hospital settings. By virtually eliminating severe hypoglycemia, maintaining control over hyperglycemia and reducing the burden on healthcare staff, EndoTool IV represents a meaningful step forward in the management of inpatient diabetes. As the company continues to expand its clinical evidence base, its technology may help redefine best practices for insulin therapy and set new standards for patient-centered, data-driven care.
About Glooko
Glooko is a global digital health company focused on helping clinicians address the growing challenges of glycemic safety and diabetes management across the care continuum. Glooko is uniquely positioned to be the enterprise partner of choice for healthcare providers seeking to reduce glycemic risk, improve safety, and support overburdened clinical teams with coordinated expertise across both outpatient and inpatient care settings.
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