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Timely access to laboratory values is critical for clinical decision-making, yet current approaches rely on invasive venous sampling and are intrinsically delayed. Electrocardiography (ECG), as a non-invasive and widely available signal, offers a promising modality for rapid laboratory estimation. Recent progress in deep learning has enabled the extraction of latent hematological signatures from ECGs. However, existing models are constrained by low signal-to-noise ratios, substantial inter-individual variability, limited data diversity, and suboptimal generalization, especially when adapted to low-lead wearable devices. In this work, we conduct an exploratory study leveraging transfer learning to fine-tune ECGFounder, a large-scale pre-trained ECG foundation model, on the Multimodal Clinical Monitoring in the Emergency Department (MC-MED) dataset from Stanford. We generated a corpus of more than 20 million standardized ten-second ECG segments to enhance sensitivity to subtle biochemical correlates. On internal validation, the model demonstrated strong predictive performance (area under the curve above 0.65) for thirty-three laboratory indicators, moderate performance (between 0.55 and 0.65) for fifty-nine indicators, and limited performance (below 0.55) for sixteen indicators. This study provides an efficient artificial-intelligence driven solution and establishes the feasibility scope for real-time, non-invasive estimation of laboratory values.

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We present DM-Bench, the first benchmark designed to evaluate large language model (LLM) performance across real-world decision-making tasks faced by individuals managing diabetes in their daily lives. Unlike prior health benchmarks that are either generic, clinician-facing or focused on clinical tasks (e.g., diagnosis, triage), DM-Bench introduces a comprehensive evaluation framework tailored to the unique challenges of prototyping patient-facing AI solutions in diabetes, glucose management, metabolic health and related domains. Our benchmark encompasses 7 distinct task categories, reflecting the breadth of real-world questions individuals with diabetes ask, including basic glucose interpretation, educational queries, behavioral associations, advanced decision making and long term planning. Towards this end, we compile a rich dataset comprising one month of time-series data encompassing glucose traces and metrics from continuous glucose monitors (CGMs) and behavioral logs (e.g., eating and activity patterns) from 15,000 individuals across three different diabetes populations (type 1, type 2, pre-diabetes/general health and wellness). Using this data, we generate a total of 360,600 personalized, contextual questions across the 7 tasks. We evaluate model performance on these tasks across 5 metrics: accuracy, groundedness, safety, clarity and actionability. Our analysis of 8 recent LLMs reveals substantial variability across tasks and metrics; no single model consistently outperforms others across all dimensions. By establishing this benchmark, we aim to advance the reliability, safety, effectiveness and practical utility of AI solutions in diabetes care.

Diabetes mellitus is a major global health challenge, affecting over half a billion adults worldwide with prevalence projected to rise. Although the American Diabetes Association (ADA) provides clear diagnostic thresholds, early recognition remains difficult due to vague symptoms, borderline laboratory values, gestational complexity, and the demands of long-term monitoring. Advances in large language models (LLMs) offer opportunities to enhance decision support through structured, interpretable, and patient-friendly outputs. This study evaluates GPT-5, the latest generative pre-trained transformer, using a simulation framework built entirely on synthetic cases aligned with ADA Standards of Care 2025 and inspired by public datasets including NHANES, Pima Indians, EyePACS, and MIMIC-IV. Five representative scenarios were tested: symptom recognition, laboratory interpretation, gestational diabetes screening, remote monitoring, and multimodal complication detection. For each, GPT-5 classified cases, generated clinical rationales, produced patient explanations, and output structured JSON summaries. Results showed strong alignment with ADA-defined criteria, suggesting GPT-5 may function as a dual-purpose tool for clinicians and patients, while underscoring the importance of reproducible evaluation frameworks for responsibly assessing LLMs in healthcare.

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.

Managing physiological variables within clinically safe target zones is a central challenge in healthcare, particularly for chronic conditions such as Type 1 Diabetes Mellitus (T1DM). Reinforcement learning (RL) offers promise for personalising treatment, but struggles with the delayed and heterogeneous effects of interventions. We propose a novel RL framework to study and support decision-making in T1DM technologies, such as automated insulin delivery. Our approach captures the complex temporal dynamics of treatment by unifying two control modalities: \textit{impulse control} for discrete, fast-acting interventions (e.g., insulin boluses), and \textit{switching control} for longer-acting treatments and regime shifts. The core of our method is a constrained Markov decision process augmented with physiological state features, enabling safe policy learning under clinical and resource constraints. The framework incorporates biologically realistic factors, including insulin decay, leading to policies that better reflect real-world therapeutic behaviour. While not intended for clinical deployment, this work establishes a foundation for future safe and temporally-aware RL in healthcare. We provide theoretical guarantees of convergence and demonstrate empirical improvements in a stylised T1DM control task, reducing blood glucose level violations from 22.4\% (state-of-the-art) to as low as 10.8\%.

In this study, we present a dual-modal AI framework based on short-wave infrared (SWIR) spectroscopy. The first modality employs a multi-wavelength SWIR imaging system coupled with convolutional neural networks (CNNs) to capture spatial features linked to glucose absorption. The second modality uses a compact photodiode voltage sensor and machine learning regressors (e.g., random forest) on normalized optical signals. Both approaches were evaluated on synthetic blood phantoms and skin-mimicking materials across physiological glucose levels (70 to 200 mg/dL). The CNN achieved a mean absolute percentage error (MAPE) of 4.82% at 650 nm with 100% Zone A coverage in the Clarke Error Grid, while the photodiode system reached 86.4% Zone A accuracy. This framework constitutes a state-of-the-art solution that balances clinical accuracy, cost efficiency, and wearable integration, paving the way for reliable continuous non-invasive glucose monitoring.

The field of health informatics has been profoundly influenced by the development of random forest models, which have led to significant advances in the interpretability of feature interactions. These models are characterized by their robustness to overfitting and parallelization, making them particularly useful in this domain. However, the increasing number of features and estimators in random forests can prevent domain experts from accurately interpreting global feature interactions, thereby compromising trust and regulatory compliance. A method called the surrogate interpretability graph has been developed to address this issue. It uses graphs and mixed-integer linear programming to analyze and visualize feature interactions. This improves their interpretability by visualizing the feature usage per decision-feature-interaction table and the most dominant hierarchical decision feature interactions for predictions. The implementation of a surrogate interpretable graph enhances global interpretability, which is critical for such a high-stakes domain.

Large language models (LLMs) have emerged as powerful tools for analyzing complex datasets. Recent studies demonstrate their potential to generate useful, personalized responses when provided with patient-specific health information that encompasses lifestyle, biomarkers, and context. As LLM-driven health applications are increasingly adopted, rigorous and efficient one-sided evaluation methodologies are crucial to ensure response quality across multiple dimensions, including accuracy, personalization and safety. Current evaluation practices for open-ended text responses heavily rely on human experts. This approach introduces human factors and is often cost-prohibitive, labor-intensive, and hinders scalability, especially in complex domains like healthcare where response assessment necessitates domain expertise and considers multifaceted patient data. In this work, we introduce Adaptive Precise Boolean rubrics: an evaluation framework that streamlines human and automated evaluation of open-ended questions by identifying gaps in model responses using a minimal set of targeted rubrics questions. Our approach is based on recent work in more general evaluation settings that contrasts a smaller set of complex evaluation targets with a larger set of more precise, granular targets answerable with simple boolean responses. We validate this approach in metabolic health, a domain encompassing diabetes, cardiovascular disease, and obesity. Our results demonstrate that Adaptive Precise Boolean rubrics yield higher inter-rater agreement among expert and non-expert human evaluators, and in automated assessments, compared to traditional Likert scales, while requiring approximately half the evaluation time of Likert-based methods. This enhanced efficiency, particularly in automated evaluation and non-expert contributions, paves the way for more extensive and cost-effective evaluation of LLMs in health.