EndoTool IV Keeps Labor and Delivery Glucose in Range Without Severe Hypoglycemia
Labor and delivery compresses diabetes management into one of the most unstable windows in obstetrics. Insulin needs can shift within minutes as placental hormones fall, oral intake changes, stress responses intensify, and delivery itself alters maternal metabolism. In that setting, a computerized intravenous insulin dosing application has to do two things at once: blunt hyperglycemia and avoid dragging glucose too low.
Real-world data presented at the Diabetes Technology Society meeting point to a narrow but important success. Across 267 pregnant individuals treated at 43 facilities in the 2025 EndoTool IV database, no severe hypoglycemia episodes were recorded during labor and delivery. Severe hypoglycemia was defined as blood glucose below 40 mg/dL. For bedside teams managing intrapartum insulin, that absence matters because severe lows are the complication most likely to force abrupt treatment changes, interrupt delivery workflows, and create maternal risk when monitoring must stay continuous.
Glucose Control Stayed Tight Across a Broad Obstetric Cohort
The retrospective analysis compared outcomes in people with type 1 diabetes and in those with gestational diabetes or type 2 diabetes. In the type 1 diabetes group, blood glucose below 60 mg/dL occurred in 0.63% of readings. In the type 2 diabetes or gestational diabetes group, that threshold was crossed in 0.16% of readings. Hyperglycemia, defined as blood glucose above 180 mg/dL, occurred in less than 10% of readings in either group, and only six readings overall exceeded 300 mg/dL.
Those numbers suggest the dosing logic was able to hold glucose in a relatively narrow corridor under the stress of labor. Eighty to 90% of patients achieved results within a glucose range of 90–120 mg/dL, a window that reflects how aggressively many obstetric diabetes protocols try to limit fetal and maternal exposure to hyperglycemia during delivery. In practical terms, the data indicate that a computerized intravenous system can keep most readings near target without the tradeoff of severe lows that often complicate manual insulin titration.
One sentence captures the most clinically relevant signal: no severe hypoglycemia occurred.
Why Intrapartum Insulin Is Hard to Get Right
Labor is a biologically volatile state. Maternal glucose can rise with stress hormones and fall quickly after delivery begins, especially when intravenous fluids, changing activity, and shifting nutritional intake collide. For people with type 1 diabetes, absolute insulin dependence makes the margin for error especially thin. For those with gestational diabetes or type 2 diabetes, the physiology differs, but the bedside challenge is similar: glucose has to be managed in real time, and every dose adjustment must fit the immediate clinical context.
A computerized dosing application is designed to reduce that friction by translating frequent glucose checks into insulin adjustments with less reliance on ad hoc bedside calculation. The appeal in labor and delivery is straightforward. A system that can respond to rapidly changing glucose values may help maintain tighter control than a fragmented manual process, particularly across units where staffing, experience, and practice patterns vary. The real-world dataset presented here fits that model, showing a low rate of hypoglycemia while hyperglycemia remained uncommon.
What the Data Suggest About Cross-Setting Diabetes Care
The broader company strategy links inpatient and outpatient diabetes management, and pregnancy is an obvious test case for that approach. Care does not begin in the delivery suite. It starts with prenatal glucose monitoring, continues through hospital-based insulin management during labor, and extends into postpartum follow-up when insulin requirements can fall sharply and diabetes status may change again. Glooko’s ambulatory pregnancy module, GestationalCare™, is intended to support review of fasting and post-meal glucose patterns, flag people who may need closer attention, and carry care through the postpartum transition.
That continuity matters because intrapartum glycemic management is only one point on a longer timeline. If outpatient data are fragmented, the inpatient team may walk into labor with an incomplete picture of glucose trends, recent insulin needs, or how often readings have drifted above goal. A connected platform aims to shorten that gap. The dataset from EndoTool IV does not prove that outpatient and inpatient linkage improves outcomes, but it does show that a computerized inpatient tool can function in the most acute phase of pregnancy care without producing a severe hypoglycemia signal in this cohort.
What the Numbers Do and Do Not Prove
These findings are encouraging, but they remain observational and retrospective. The 267 individuals came from a 2025 database rather than a randomized comparison, so the data cannot separate the effect of the software from local protocols, clinician expertise, or selection factors at the 43 participating facilities. The analysis also does not establish whether outcomes would differ from those achieved with another protocol or with manual insulin management in the same clinical environment.
Even so, the pattern is hard to ignore. Blood glucose values stayed in a tight range for most patients, severe hypoglycemia did not occur, and hyperglycemia remained infrequent. For labor and delivery teams, that combination suggests a dosing system that can adapt to the abrupt metabolic shifts of childbirth without overshooting into dangerous low glucose territory.
Joseph Aloi, MD, section chief of Endocrinology and Metabolism at Advocate Health and Wake Forest University School of Medicine, framed the result around the specific challenge of the intrapartum period, where insulin requirements can change quickly and clinicians must preserve tight control while limiting hypoglycemia risk. Mark Clements, MD, PhD, chief medical and strategy officer at Glooko, placed the findings in the context of pregnancy as a continuum, spanning outpatient monitoring, labor and delivery, and postpartum support.
The unresolved issue is comparative performance: whether this approach outperforms other intrapartum insulin strategies, and in which subgroups the benefit is greatest. Until head-to-head data arrive, the most defensible reading is narrower. EndoTool IV produced tight glycemic control across a mixed obstetric cohort, with no severe hypoglycemia and only rare marked hyperglycemia during labor and delivery.