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Abstract BackgroundEffective diabetes management requires precise glycemic control to prevent both hypoglycemia and hyperglycemia, yet existing machine learning (ML) and reinforcement learning (RL) approaches often fail to balance competing objectives. Traditional RL-based glucose regulation systems primarily focus on single-objective optimization, overlooking factors such as minimizing insulin overuse, reducing glycemic variability, and ensuring patient safety. Furthermore, these approaches typically rely on centralized data processing, which raises privacy concerns due to the sensitive nature of health care data. There is a critical need for a decentralized, privacy-preserving framework that can personalize blood glucose regulation while addressing the multiobjective nature of diabetes management. ObjectiveThis study aimed to develop and validate PRIMO-FRL (Privacy-Preserving Reinforcement Learning for Individualized Multi-Objective Glycemic Management Using Federated Reinforcement Learning), a novel framework that optimizes clinical objectives—maximizing time in range (TIR), reducing hypoglycemia and hyperglycemia, and minimizing glycemic risk—while preserving patient privacy. MethodsWe developed PRIMO-FRL, integrating multiobjective reward shaping to dynamically balance glucose stability, insulin efficiency, and risk reduction. The model was trained and tested using simulated data from 30 simulated patients (10 children, 10 adolescents, and 10 adults) generated with the Food and Drug Administration (FDA)–approved UVA/Padova simulator. A comparative analysis was conducted against state-of-the-art RL and ML models, evaluating performance using metrics such as TIR, hypoglycemia (<70 mg/dL), hyperglycemia (>180 mg/dL), and glycemic risk scores. ResultsThe PRIMO-FRL model achieved a robust overall TIR of 76.54%, with adults demonstrating the highest TIR at 81.48%, followed by children at 77.78% and adolescents at 70.37%. Importantly, the approach eliminated hypoglycemia, with 0.0% spent below 70 mg/dL across all cohorts, significantly outperforming existing methods. Mild hyperglycemia (180-250 mg/dL) was observed in adolescents (29.63%), children (22.22%), and adults (18.52%), with adults exhibiting the best control. Furthermore, the PRIMO-FRL approach consistently reduced glycemic risk scores, demonstrating improved safety and long-term stability in glucose regulation.. ConclusionsOur findings highlight the potential of PRIMO-FRL as a transformative, privacy-preserving approach to personalized glycemic management. By integrating federated RL, this framework eliminates hypoglycemia, improves TIR, and preserves data privacy by decentralizing model training. Unlike traditional centralized approaches that require sharing sensitive health data, PRIMO-FRL leverages federated learning to keep patient data local, significantly reducing privacy risks while enabling adaptive and personalized glucose control. This multiobjective optimization strategy offers a scalable, secure, and clinically viable solution for real-world diabetes care. The ability to train personalized models across diverse populations without exposing raw data makes PRIMO-FRL well-suited for deployment in privacy-sensitive health care environments. These results pave the way for future clinical adoption, demonstrating the potential of privacy-preserving artificial intelligence in optimizing glycemic regulation while maintaining security, adaptability, and personalization.
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Personalized Diabetes Management with Digital Twins: A Patient-Centric Knowledge Graph Approach
Diabetes management requires constant monitoring and individualized adjustments. This study proposes a novel approach that leverages digital twins and personal health knowledge graphs (PHKGs) to revolutionize diabetes care. Our key contribution lies in developing a real-time, patient-centric digital twin framework built on PHKGs. This framework integrates data from diverse sources, adhering to HL7 standards and enabling seamless information access and exchange while ensuring high levels of accuracy in data representation and health insights. PHKGs offer a flexible and efficient format that supports various applications. As new knowledge about the patient becomes available, the PHKG can be easily extended to incorporate it, enhancing the precision and accuracy of the care provided. This dynamic approach fosters continuous improvement and facilitates the development of new applications. As a proof of concept, we have demonstrated the versatility of our digital twins by applying it to different use cases in diabetes management. These include predicting glucose levels, optimizing insulin dosage, providing personalized lifestyle recommendations, and visualizing health data. By enabling real-time, patient-specific care, this research paves the way for more precise and personalized healthcare interventions, potentially improving long-term diabetes management outcomes.
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- PAR ID:
- 10524596
- Publisher / Repository:
- Journal of Personalized Medicine
- Date Published:
- Journal Name:
- Journal of Personalized Medicine
- Volume:
- 14
- Issue:
- 4
- ISSN:
- 2075-4426
- Page Range / eLocation ID:
- 359
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.3390/jpm14040359
