Control of blood glucose is essential for diabetes management. Current digital therapeutic approaches for subjects with Type 1 diabetes mellitus (T1DM) such as the artificial pancreas and insulin bolus calculators leverage machine learning techniques for predicting subcutaneous glucose for improved control. Deep learning has recently been applied in healthcare and medical research to achieve state-of-the-art results in a range of tasks including disease diagnosis, and patient state prediction among others. In this work, we present a deep learning model that is capable of forecasting glucose levels with leading accuracy for simulated patient cases (RMSE = 9.38±0.71 [mg/dL] over a 30-minute horizon, RMSE = 18.87±2.25 [mg/dL] over a 60-minute horizon) and real patient cases (RMSE = 21.07±2.35 [mg/dL] for 30-minute, RMSE = 33.27±4.79\% for 60-minute). In addition, the model provides competitive performance in providing effective prediction horizon ( $PH_{eff}$ ) with minimal time lag both in a simulated patient dataset ( $PH_{eff}$ = 29.0±0.7 for 30-min and $PH_{eff}$ = 49.8±2.9 for 60-min) and in a real patient dataset ( $PH_{eff}$ = 19.3±3.1 for 30-min and $PH_{eff}$ = 29.3±9.4 for 60-min). This approach is evaluated on a dataset of 10 simulated cases generated from the UVa/Padova simulator and a clinical dataset of 10 real cases each containing glucose readings, insulin bolus, and meal (carbohydrate) data. Performance of the recurrent convolutional neural network is benchmarked against four algorithms. The proposed algorithm is implemented on an Android mobile phone, with an execution time of 6ms on a phone compared to an execution time of 780ms on a laptop.

Diabetes is a chronic metabolic disorder that affects an estimated 463 million people worldwide. Aiming to improve the treatment of people with diabetes, digital health has been widely adopted in recent years and generated a huge amount of data that could be used for further management of this chronic disease. Taking advantage of this, approaches that use artificial intelligence and specifically deep learning, an emerging type of machine learning, have been widely adopted with promising results. In this paper, we present a comprehensive review of the applications of deep learning within the field of diabetes. We conducted a systematic literature search and identified three main areas that use this approach: diagnosis of diabetes, glucose management, and diagnosis of diabetes-related complications. The search resulted in the selection of 40 original research articles, of which we have summarized the key information about the employed learning models, development process, main outcomes, and baseline methods for performance evaluation. Among the analyzed literature, it is to be noted that various deep learning techniques and frameworks have achieved state-of-the-art performance in many diabetes-related tasks by outperforming conventional machine learning approaches. Meanwhile, we identify some limitations in the current literature, such as a lack of data availability and model interpretability. The rapid developments in deep learning and the increase in available data offer the possibility to meet these challenges in the near future and allow the widespread deployment of this technology in clinical settings.

For people with Type 1 diabetes (T1D), forecasting of \red{blood glucose (BG)} can be used to effectively avoid hyperglycemia, hypoglycemia and associated complications. The latest continuous glucose monitoring (CGM) technology allows people to observe glucose in real-time. However, an accurate glucose forecast remains a challenge. In this work, we introduce GluNet, a framework that leverages on a personalized deep neural network to predict the probabilistic distribution of short-term (30-60 minutes) future CGM measurements for subjects with T1D based on their historical data including glucose measurements, meal information, insulin doses, and other factors. It adopts the latest deep learning techniques consisting of four components: data pre-processing, label transform/recover, multi-layers of dilated convolution neural network (CNN), and post-processing. The method is evaluated $in-silico$ for both adult and adolescent subjects. The results show significant improvements over existing methods in the literature through a comprehensive comparison in terms of root mean square error (RMSE) (8.88 ± 0.77 mg/dL) with short time lag (0.83 ± 0.40 minutes) for prediction horizons (PH) = 30 mins (minutes), and RMSE (19.90 ± 3.17 mg/dL) with time lag (16.43 ± 4.07 mins) for PH = 60 mins for virtual adult subjects. In addition, GluNet is also tested on two clinical data sets. Results show that it achieves an RMSE (19.28 ± 2.76 mg/dL) with time lag (8.03 ± 4.07 mins) for PH = 30 mins and an RMSE (31.83 ± 3.49 mg/dL) with time lag (17.78 ± 8.00 mins) for PH = 60 mins. These are the best reported results for glucose forecasting when compared with other methods including the neural network for predicting glucose (NNPG), the support vector regression (SVR), the latent variable with exogenous input (LVX), and the auto regression with exogenous input (ARX) algorithm.

Clinical decision support systems (CDSS) for antimicrobial management can support clinicians to optimize antimicrobial therapy. We reviewed all original literature (qualitative and quantitative) to understand the current scope of CDSS for antimicrobial management and analyse existing methods used to evaluate and report such systems. PRISMA guidelines were followed. Medline, EMBASE, HMIC Health and Management and Global Health databases were searched from 1 January 1980 to 31 October 2015. All primary research studies describing CDSS for antimicrobial management in adults in primary or secondary care were included. For qualitative studies, thematic synthesis was performed. Quality was assessed using Integrated quality Criteria for the Review Of Multiple Study designs (ICROMS) criteria. CDSS reporting was assessed against a reporting framework for behaviour change intervention implementation. Fifty-eight original articles were included describing 38 independent CDSS. The majority of systems target antimicrobial prescribing (29/38;76%), are platforms integrated with electronic medical records (28/38;74%), and have a rules-based infrastructure providing decision support (29/38;76%). On evaluation against the intervention reporting framework, CDSS studies fail to report consideration of the non-expert, end-user workflow. They have narrow focus, such as antimicrobial selection, and use proxy outcome measures. Engagement with CDSS by clinicians was poor. Greater consideration of the factors that drive non-expert decision making must be considered when designing CDSS interventions. Future work must aim to expand CDSS beyond simply selecting appropriate antimicrobials with clear and systematic reporting frameworks for CDSS interventions developed to address current gaps identified in the reporting of evidence.

Blood glucose (BG) prediction is essential to the success of glycemic control in type 1 diabetes (T1D) management. Empowered by the recent development of the Internet of Medical Things (IoMT), continuous glucose monitoring (CGM) and deep learning technologies have been demonstrated to achieve the state of the art in BG prediction. However, it is challenging to implement such algorithms in actual clinical settings to provide persistent decision support due to the high demand for computational resources, while smartphone-based implementations are limited by short battery life and require users to carry the device. In this work, we propose a new deep learning model using an attention-based evidential recurrent neural network and design an IoMT-enabled wearable device to implement the embedded model, which comprises a low-cost and low-power system on a chip to perform Bluetooth connectivity and edge computing for real-time BG prediction and predictive hypoglycemia detection. In addition, we developed a smartphone app to visualize BG trajectories and predictions, and desktop and cloud platforms to backup data and fine-tune models. The embedded model was evaluated on three clinical data sets including 47 T1D subjects. The proposed model achieved superior performance of root mean square error (RMSE), mean absolute error, and glucose-specific RMSE, and obtained the best accuracy for hypoglycemia detection when compared with a group of machine learning baseline methods. Moreover, we performed hardware-in-the-loop in silico trials with ten virtual T1D adults to test the whole IoMT system with predictive low-glucose management, which significantly reduced hypoglycemia and improved BG control.

The availability of large amounts of data from continuous glucose monitoring (CGM), together with the latest advances in deep learning techniques, have opened the door to a new paradigm of algorithm design for personalized blood glucose (BG) prediction in type 1 diabetes (T1D) with superior performance. However, there are several challenges that prevent the widespread implementation of deep learning algorithms in actual clinical settings, including unclear prediction confidence and limited training data for new T1D subjects. To this end, we propose a novel deep learning framework, Fast-adaptive and Confident Neural Network (FCNN), to meet these clinical challenges. In particular, an attention-based recurrent neural network is used to learn representations from CGM input and forward a weighted sum of hidden states to an evidential output layer, aiming to compute personalized BG predictions with theoretically supported model confidence. The model-agnostic meta-learning is employed to enable fast adaptation for a new T1D subject with limited training data. The proposed framework has been validated on three clinical datasets. In particular, for a dataset including 12 subjects with T1D, FCNN achieved a root mean square error of 18.64±2.60 mg/dL and 31.07±3.62 mg/dL for 30 and 60-minute prediction horizons, respectively, which outperformed all the considered baseline methods with significant improvements. These results indicate that FCNN is a viable and effective approach for predicting BG levels in T1D. The well-trained models can be implemented in smartphone apps to improve glycemic control by enabling proactive actions through real-time glucose alerts.