This paper proposes GluMind, a transformer-based multimodal framework designed for continual and long-term blood glucose forecasting. GluMind devises two attention mechanisms, including cross-attention and multi-scale attention, which operate in parallel and deliver accurate predictive performance. Cross-attention effectively integrates blood glucose data with other physiological and behavioral signals such as activity, stress, and heart rate, addressing challenges associated with varying sampling rates and their adverse impacts on robust prediction. Moreover, the multi-scale attention mechanism captures long-range temporal dependencies. To mitigate catastrophic forgetting, GluMind incorporates a knowledge retention technique into the transformer-based forecasting model. The knowledge retention module not only enhances the model's ability to retain prior knowledge but also boosts its overall forecasting performance. We evaluate GluMind on the recently released AIREADI dataset, which contains behavioral and physiological data collected from healthy people, individuals with prediabetes, and those with type 2 diabetes. We examine the performance stability and adaptability of GluMind in learning continuously as new patient cohorts are introduced. Experimental results show that GluMind consistently outperforms other state-of-the-art forecasting models, achieving approximately 15% and 9% improvements in root mean squared error (RMSE) and mean absolute error (MAE), respectively.

Diabetes mellitus is a growing global health issue, with Type 1 Diabetes (T1D) requiring constant monitoring to avoid hypoglycemia. Although Continuous Glucose Monitors (CGMs) are effective, their cost and invasiveness limit access, particularly in low-resource settings. This paper proposes a non-invasive method to classify glycemic states using Galvanic Skin Response (GSR), a biosignal commonly captured by wearable sensors. We use the merged OhioT1DM 2018 and 2020 datasets to build a machine learning pipeline that detects hypoglycemia (glucose < 70 mg/dl) and normoglycemia (glucose > 70 mg/dl) with GSR alone. Seven models are trained and evaluated: Random Forest, XGBoost, MLP, CNN, LSTM, Logistic Regression, and K-Nearest Neighbors. Validation sets and 95% confidence intervals are reported to increase reliability and assess robustness. Results show that the LSTM model achieves a perfect hypoglycemia recall (1.00) with an F1-score confidence interval of [0.611-0.745], while XGBoost offers strong performance with a recall of 0.54 even under class imbalance. This approach highlights the potential for affordable, wearable-compatible glucose monitoring tools suitable for settings with limited CGM availability using GSR data. Index Terms: Hypoglycemia Detection, Galvanic Skin Response, Non Invasive Monitoring, Wearables, Machine Learning, Confidence Intervals.

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Reinforcement learning (RL)-based dynamic treatment regimes (DTRs) hold promise for automating complex clinical decision-making, yet their practical deployment remains hindered by the intensive engineering required to inject clinical knowledge and ensure patient safety. Recent advancements in large language models (LLMs) suggest a complementary approach, where implicit prior knowledge and clinical heuristics are naturally embedded through linguistic prompts without requiring environment-specific training. In this study, we rigorously evaluate open-source LLMs as dynamic insulin dosing agents in an in silico Type 1 diabetes simulator, comparing their zero-shot inference performance against small neural network-based RL agents (SRAs) explicitly trained for the task. Our results indicate that carefully designed zero-shot prompts enable smaller LLMs (e.g., Qwen2.5-7B) to achieve comparable or superior clinical performance relative to extensively trained SRAs, particularly in stable patient cohorts. However, LLMs exhibit notable limitations, such as overly aggressive insulin dosing when prompted with chain-of-thought (CoT) reasoning, highlighting critical failure modes including arithmetic hallucination, temporal misinterpretation, and inconsistent clinical logic. Incorporating explicit reasoning about latent clinical states (e.g., meals) yielded minimal performance gains, underscoring the current model's limitations in capturing complex, hidden physiological dynamics solely through textual inference. Our findings advocate for cautious yet optimistic integration of LLMs into clinical workflows, emphasising the necessity of targeted prompt engineering, careful validation, and potentially hybrid approaches that combine linguistic reasoning with structured physiological modelling to achieve safe, robust, and clinically effective decision-support systems.

High quality real world datasets are essential for advancing data driven approaches in type 1 diabetes (T1D) management, including personalized therapy design, digital twin systems, and glucose prediction models. However, progress in this area has been limited by the scarcity of publicly available datasets that offer detailed and comprehensive patient data. To address this gap, we present AZT1D, a dataset containing data collected from 25 individuals with T1D on automated insulin delivery (AID) systems. AZT1D includes continuous glucose monitoring (CGM) data, insulin pump and insulin administration data, carbohydrate intake, and device mode (regular, sleep, and exercise) obtained over 6 to 8 weeks for each patient. Notably, the dataset provides granular details on bolus insulin delivery (i.e., total dose, bolus type, correction specific amounts) features that are rarely found in existing datasets. By offering rich, naturalistic data, AZT1D supports a wide range of artificial intelligence and machine learning applications aimed at improving clinical decision making and individualized care in T1D.

Managing Type 1 Diabetes (T1D) demands constant vigilance as individuals strive to regulate their blood glucose levels to avert the dangers of dysglycemia (hyperglycemia or hypoglycemia). Despite the advent of sophisticated technologies such as automated insulin delivery (AID) systems, achieving optimal glycemic control remains a formidable task. AID systems integrate continuous subcutaneous insulin infusion (CSII) and continuous glucose monitors (CGM) data, offering promise in reducing variability and increasing glucose time-in-range. However, these systems often fail to prevent dysglycemia, partly due to limitations in prediction algorithms that lack the precision to avert abnormal glucose events. This gap highlights the need for proactive behavioral adjustments. We address this need with GLIMMER, Glucose Level Indicator Model with Modified Error Rate, a machine learning approach for forecasting blood glucose levels. GLIMMER categorizes glucose values into normal and abnormal ranges and devises a novel custom loss function to prioritize accuracy in dysglycemic events where patient safety is critical. To evaluate the potential of GLIMMER for T1D management, we both use a publicly available dataset and collect new data involving 25 patients with T1D. In predicting next-hour glucose values, GLIMMER achieved a root mean square error (RMSE) of 23.97 (+/-3.77) and a mean absolute error (MAE) of 15.83 (+/-2.09) mg/dL. These results reflect a 23% improvement in RMSE and a 31% improvement in MAE compared to the best-reported error rates.

Diabetes is a chronic metabolic disorder characterized by persistently high blood glucose levels (BGLs), leading to severe complications such as cardiovascular disease, neuropathy, and retinopathy. Predicting BGLs enables patients to maintain glucose levels within a safe range and allows caregivers to take proactive measures through lifestyle modifications. Continuous Glucose Monitoring (CGM) systems provide real-time tracking, offering a valuable tool for monitoring BGLs. However, accurately forecasting BGLs remains challenging due to fluctuations due to physical activity, diet, and other factors. Recent deep learning models show promise in improving BGL prediction. Nonetheless, forecasting BGLs accurately from multimodal, irregularly sampled data over long prediction horizons remains a challenging research problem. In this paper, we propose AttenGluco, a multimodal Transformer-based framework for long-term blood glucose prediction. AttenGluco employs cross-attention to effectively integrate CGM and activity data, addressing challenges in fusing data with different sampling rates. Moreover, it employs multi-scale attention to capture long-term dependencies in temporal data, enhancing forecasting accuracy. To evaluate the performance of AttenGluco, we conduct forecasting experiments on the recently released AIREADI dataset, analyzing its predictive accuracy across different subject cohorts including healthy individuals, people with prediabetes, and those with type 2 diabetes. Furthermore, we investigate its performance improvements and forgetting behavior as new cohorts are introduced. Our evaluations show that AttenGluco improves all error metrics, such as root mean square error (RMSE), mean absolute error (MAE), and correlation, compared to the multimodal LSTM model. AttenGluco outperforms this baseline model by about 10% and 15% in terms of RMSE and MAE, respectively.

Type 1 Diabetes is a chronic autoimmune condition in which the immune system attacks and destroys insulin-producing beta cells in the pancreas, resulting in little to no insulin production. Insulin helps glucose in your blood enter your muscle, fat, and liver cells so they can use it for energy or store it for later use. If insulin is insufficient, it causes sugar to build up in the blood and leads to serious health problems. People with Type 1 Diabetes need synthetic insulin every day. In diabetes management, continuous glucose monitoring is an important feature that provides near real-time blood glucose data. It is useful in deciding the synthetic insulin dose. In this research work, we used machine learning tools, deep neural networks, deep reinforcement learning, and voting and stacking regressors to predict blood glucose levels at 30-min time intervals using the latest DiaTrend dataset. Predicting blood glucose levels is useful in better diabetes management systems. The trained models were compared using several evaluation metrics. Our evaluation results demonstrate the performance of various models across different glycemic conditions for blood glucose prediction. The source codes of this work can be found in: https://github.com/soon-jynn-chu/t1d_bg_prediction

The availability of continuous glucose monitors as over-the-counter commodities have created a unique opportunity to monitor a person's blood glucose levels, forecast blood glucose trajectories and provide automated interventions to prevent devastating chronic complications that arise from poor glucose control. However, forecasting blood glucose levels is challenging because blood glucose changes consistently in response to food intake, medication intake, physical activity, sleep, and stress. It is particularly difficult to accurately predict BGL from multimodal and irregularly sampled data and over long prediction horizons. Furthermore, these forecasting models must operate in real-time on edge devices to provide in-the-moment interventions. To address these challenges, we propose GlucoNet, an AI-powered sensor system for continuously monitoring behavioral and physiological health and robust forecasting of blood glucose patterns. GlucoNet devises a feature decomposition-based transformer model that incorporates patients' behavioral and physiological data and transforms sparse and irregular patient data (e.g., diet and medication intake data) into continuous features using a mathematical model, facilitating better integration with the BGL data. Given the non-linear and non-stationary nature of BG signals, we propose a decomposition method to extract both low and high-frequency components from the BGL signals, thus providing accurate forecasting. To reduce the computational complexity, we also propose to employ knowledge distillation to compress the transformer model. GlucoNet achieves a 60% improvement in RMSE and a 21% reduction in the number of parameters, using data obtained involving 12 participants with T1-Diabetes. These results underscore GlucoNet's potential as a compact and reliable tool for real-world diabetes prevention and management.

Accurate prediction of future blood glucose (BG) levels can effectively improve BG management for people living with diabetes, thereby reducing complications and improving quality of life. The state of the art of BG prediction has been achieved by leveraging advanced deep learning methods to model multi-modal data, i.e., sensor data and self-reported event data, organised as multi-variate time series (MTS). However, these methods are mostly regarded as ``black boxes'' and not entirely trusted by clinicians and patients. In this paper, we propose interpretable graph attentive recurrent neural networks (GARNNs) to model MTS, explaining variable contributions via summarizing variable importance and generating feature maps by graph attention mechanisms instead of post-hoc analysis. We evaluate GARNNs on four datasets, representing diverse clinical scenarios. Upon comparison with twelve well-established baseline methods, GARNNs not only achieve the best prediction accuracy but also provide high-quality temporal interpretability, in particular for postprandial glucose levels as a result of corresponding meal intake and insulin injection. These findings underline the potential of GARNN as a robust tool for improving diabetes care, bridging the gap between deep learning technology and real-world healthcare solutions.