-- Type 1 Diabetes (T1D) affects millions worldwide, requiring continuous monitoring to prevent severe hypo-and hyperglycemic events. While continuous glucose monitoring has improved blood glucose management, deploying predictive models on wearable devices remains challenging due to computational and memory constraints. T o address this, we propose a novel Lightweight Sequential Transformer model designed for blood glucose prediction in T1D. The model is optimized for deployment on resource-constrained edge devices and incorporates a balanced loss function to handle the inherent data imbalance in hypo-and hyperglycemic events. Experiments on two benchmark datasets, OhioT1DM and DiaTrend, demonstrate that the proposed model outperforms state-of-the-art methods in predicting glucose levels and detecting adverse events. This work fills the gap between high-performance modeling and practical deployment, providing a reliable and efficient T1D management solution. Type 1 Diabetes (T1D) [1] is a chronic autoimmune condition requiring lifelong blood glucose concentration (BGC) monitoring to prevent life-threatening complications such as hypoglycemia (BGC below 70 mg/dL [2]) and hyperglycemia (BGC above 180 mg/dL [3]).

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.

Accurate blood glucose prediction can enable novel interventions for type 1 diabetes treatment, including personalized insulin and dietary adjustments. Although recent advances in transformer-based architectures have demonstrated the power of attention mechanisms in complex multivariate time series prediction, their potential for blood glucose (BG) prediction remains underexplored. We present a comparative analysis of transformer models for multi-horizon BG prediction, examining forecasts up to 4 hours and input history up to 1 week. The publicly available DCLP3 dataset (n=112) was split (80%-10%-10%) for training, validation, and testing, and the OhioT1DM dataset (n=12) served as an external test set. We trained networks with point-wise, patch-wise, series-wise, and hybrid embeddings, using CGM, insulin, and meal data. For short-term blood glucose prediction, Crossformer, a patch-wise transformer architecture, achieved a superior 30-minute prediction of RMSE (15.6 mg / dL on OhioT1DM). For longer-term predictions (1h, 2h, and 4h), PatchTST, another path-wise transformer, prevailed with the lowest RMSE (24.6 mg/dL, 36.1 mg/dL, and 46.5 mg/dL on OhioT1DM). In general, models that used tokenization through patches demonstrated improved accuracy with larger input sizes, with the best results obtained with a one-week history. These findings highlight the promise of transformer-based architectures for BG prediction by capturing and leveraging seasonal patterns in multivariate time-series data to improve accuracy.

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.

While previous studies of AI in diabetes management focus on long-term risk, research on near-future glucose prediction remains limited but important as it enables timely diabetes self-management. Integrating AI with continuous glucose monitoring (CGM) holds promise for near-future glucose prediction. However, existing models have limitations in capturing patterns of blood glucose fluctuations and demonstrate poor generalizability. A robust approach is needed to leverage massive CGM data for near-future glucose prediction. We propose large sensor models (LSMs) to capture knowledge in CGM data by modeling patients as sequences of glucose. CGM-LSM is pretrained on 15.96 million glucose records from 592 diabetes patients for near-future glucose prediction. We evaluated CGM-LSM against state-of-the-art methods using the OhioT1DM dataset across various metrics, prediction horizons, and unseen patients. Additionally, we assessed its generalizability across factors like diabetes type, age, gender, and hour of day. CGM-LSM achieved exceptional performance, with an rMSE of 29.81 mg/dL for type 1 diabetes patients and 23.49 mg/dL for type 2 diabetes patients in a two-hour prediction horizon. For the OhioT1DM dataset, CGM-LSM achieved a one-hour rMSE of 15.64 mg/dL, halving the previous best of 31.97 mg/dL. Robustness analyses revealed consistent performance not only for unseen patients and future periods, but also across diabetes type, age, and gender. The model demonstrated adaptability to different hours of day, maintaining accuracy across periods of various activity intensity levels. CGM-LSM represents a transformative step in diabetes management by leveraging pretraining to uncover latent glucose generation patterns in sensor data. Our findings also underscore the broader potential of LSMs to drive innovation across domains involving complex sensor data.

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.

One of the biggest challenges of building artificial intelligence (AI) model in healthcare area is the data sharing. Since healthcare data is private, sensitive, and heterogeneous, collecting sufficient data for modelling is exhausted, costly, and sometimes impossible. In this paper, we propose a framework for global healthcare modelling using datasets from multi-continents (Europe, North America and Asia) while without sharing the local datasets, and choose glucose management as a study model to verify its effectiveness. Technically, blockchain-enabled federated learning is implemented with adaption to make it meet with the privacy and safety requirements of healthcare data, meanwhile rewards honest participation and penalize malicious activities using its on-chain incentive mechanism. Experimental results show that the proposed framework is effective, efficient, and privacy preserved. Its prediction accuracy is much better than the models trained from limited personal data and is similar to, and even slightly better than, the results from a centralized dataset. This work paves the way for international collaborations on healthcare projects, where additional data is crucial for reducing bias and providing benefits to humanity.

Continuous glucose monitoring (CGM) devices provide real-time glucose monitoring and timely alerts for glycemic excursions, improving glycemic control among patients with diabetes. However, identifying rare events like hypoglycemia and hyperglycemia remain challenging due to their infrequency. Moreover, limited access to sensitive patient data hampers the development of robust machine learning models. Our objective is to accurately predict glycemic excursions while addressing data privacy concerns. To tackle excursion prediction, we propose a novel Hypo-Hyper (HH) loss function, which significantly improves performance in the glycemic excursion regions. The HH loss function demonstrates a 46% improvement over mean-squared error (MSE) loss across 125 patients. To address privacy concerns, we propose FedGlu, a machine learning model trained in a federated learning (FL) framework. FL allows collaborative learning without sharing sensitive data by training models locally and sharing only model parameters across other patients. FedGlu achieves a 35% superior glycemic excursion detection rate compared to local models. This improvement translates to enhanced performance in predicting both, hypoglycemia and hyperglycemia, for 105 out of 125 patients. These results underscore the effectiveness of the proposed HH loss function in augmenting the predictive capabilities of glucose predictions. Moreover, implementing models within a federated learning framework not only ensures better predictive capabilities but also safeguards sensitive data concurrently.

Newly diagnosed Type 1 Diabetes (T1D) patients often struggle to obtain effective Blood Glucose (BG) prediction models due to the lack of sufficient BG data from Continuous Glucose Monitoring (CGM), presenting a significant "cold start" problem in patient care. Utilizing population models to address this challenge is a potential solution, but collecting patient data for training population models in a privacy-conscious manner is challenging, especially given that such data is often stored on personal devices. Considering the privacy protection and addressing the "cold start" problem in diabetes care, we propose "GluADFL", blood Glucose prediction by Asynchronous Decentralized Federated Learning. We compared GluADFL with eight baseline methods using four distinct T1D datasets, comprising 298 participants, which demonstrated its superior performance in accurately predicting BG levels for cross-patient analysis. Furthermore, patients' data might be stored and shared across various communication networks in GluADFL, ranging from highly interconnected (e.g., random, performs the best among others) to more structured topologies (e.g., cluster and ring), suitable for various social networks. The asynchronous training framework supports flexible participation. By adjusting the ratios of inactive participants, we found it remains stable if less than 70% are inactive. Our results confirm that GluADFL offers a practical, privacy-preserving solution for BG prediction in T1D, significantly enhancing the quality of diabetes management.

The global diabetes epidemic highlights the importance of maintaining good glycemic control. Glucose prediction is a fundamental aspect of diabetes management, facilitating real-time decision-making. Recent research has introduced models focusing on long-term glucose trend prediction, which are unsuitable for real-time decision-making and result in delayed responses. Conversely, models designed to respond to immediate glucose level changes cannot analyze glucose variability comprehensively. Moreover, contemporary research generally integrates various physiological parameters (e.g. insulin doses, food intake, etc.), which inevitably raises data privacy concerns. To bridge such a research gap, we propose TimeGlu -- an end-to-end pipeline for short-term glucose prediction solely based on CGM time series data. We implement four baseline methods to conduct a comprehensive comparative analysis of the model's performance. Through extensive experiments on two contrasting datasets (CGM Glucose and Colas dataset), TimeGlu achieves state-of-the-art performance without the need for additional personal data from patients, providing effective guidance for real-world diabetic glucose management.