BackgroundEbola virus disease (EVD) is associated with multisystem organ failure and high mortality. Severe hypoglycaemia is common, life-threatening, and correctable in critically ill patients, but glucose monitoring may be limited in EVD treatment units. MethodsWe conducted a retrospective review of patients admitted to EVD treatment units in Butembo and Katwa, Eastern DRC. Glucose measurements were done using a handheld glucometer at the bedside or using the Piccolo xpress Chemistry Analyzer on venous samples. Findings384 patients (median age 30 years (interquartile range, IQR, 20-45), 57% female) and 6,422 glucose measurements (median 11 per patient, IQR 4 to 22) were included in the analysis. Severe hypoglycaemia (≤2.2mmol/L) and hyperglycaemia (>10mmol/L) were recorded at least once during the ETU admission in 97 (25%) and 225 (59%) patients, respectively. A total of 2,004 infusions of glucose-containing intravenous solutions were administered to 302 patients (79%) with a median cumulative dose of 175g (IQR 100 to 411). The overall case fatality rate was 157/384 (41%) and was 2.2-fold higher (95%CI 1.3 to 3.8) in patients with severe hypoglycaemia than those without hypoglycaemia (p=0.0042). In a multivariable Cox proportional hazards model, periods of severe hypoglycaemia (adjusted hazard ratio (aHR) 6.2, 95%CI 3.2-12, p<0.0001) and moderate hypoglycaemia (aHR 3.0, 95%CI 1.9-4.8, p<0.0001) were associated with elevated mortality. InterpretationHypoglycaemia is common in EVD, requires repeated correction with intravenous dextrose solutions, and is associated with mortality. FundingThis study was not supported by any specific funding.