Artificial intelligence (AI) use in diabetes care is increasingly being explored to personalise care for people with diabetes and adapt treatments for complex presentations. However, the rapid advancement of AI also introduces challenges such as potential biases, ethical considerations, and implementation challenges in ensuring that its deployment is equitable. Ensuring inclusive and ethical developments of AI technology can empower both health-care providers and people with diabetes in managing the condition. In this Review, we explore and summarise the current and future prospects of AI across the diabetes care continuum, from enhancing screening and diagnosis to optimising treatment and predicting and managing complications.
Diabetes poses a considerable global health challenge, with varying levels of diabetes knowledge among healthcare professionals, highlighting the importance of diabetes training. Large Language Models (LLMs) provide new insights into diabetes training, but their performance in diabetes-related queries remains uncertain, especially outside the English language like Chinese. We first evaluated the performance of ten LLMs: ChatGPT-3.5, ChatGPT-4.0, Google Bard, LlaMA-7B, LlaMA2-7B, Baidu ERNIE Bot, Ali Tongyi Qianwen, MedGPT, HuatuoGPT, and Chinese LlaMA2-7B on diabetes-related queries, based on the Chinese National Certificate Examination for Primary Diabetes Care in China (NCE-CPDC) and the English Specialty Certificate Examination in Endocrinology and Diabetes of Membership of the Royal College of Physicians of the United Kingdom. Second, we assessed the training of primary care physicians (PCPs) without and with the assistance of ChatGPT-4.0 in the NCE-CPDC examination to ascertain the reliability of LLMs as medical assistants. We found that ChatGPT-4.0 outperformed other LLMs in the English examination, achieving a passing accuracy of 62.50%, which was significantly higher than that of Google Bard, LlaMA-7B, and LlaMA2-7B. For the NCE-CPFC examination, ChatGPT-4.0, Ali Tongyi Qianwen, Baidu ERNIE Bot, Google Bard, MedGPT, and ChatGPT-3.5 successfully passed, whereas LlaMA2-7B, HuatuoGPT, Chinese LLaMA2-7B, and LlaMA-7B failed. ChatGPT-4.0 (84.82%) surpassed all PCPs and assisted most PCPs in the NCE-CPDC examination (improving by 1 %-6.13%). In summary, LLMs demonstrated outstanding competence for diabetes-related questions in both the Chinese and English language, and hold great potential to assist future diabetes training for physicians globally.
Primary diabetes care and diabetic retinopathy (DR) screening persist as major public health challenges due to a shortage of trained primary care physicians (PCPs), particularly in low-resource settings. Here, to bridge the gaps, we developed an integrated image-language system (DeepDR-LLM), combining a large language model (LLM module) and image-based deep learning (DeepDR-Transformer), to provide individualized diabetes management recommendations to PCPs. In a retrospective evaluation, the LLM module demonstrated comparable performance to PCPs and endocrinology residents when tested in English and outperformed PCPs and had comparable performance to endocrinology residents in Chinese. For identifying referable DR, the average PCP's accuracy was 81.0% unassisted and 92.3% assisted by DeepDR-Transformer. Furthermore, we performed a single-center real-world prospective study, deploying DeepDR-LLM. We compared diabetes management adherence of patients under the unassisted PCP arm (n = 397) with those under the PCP+DeepDR-LLM arm (n = 372). Patients with newly diagnosed diabetes in the PCP+DeepDR-LLM arm showed better self-management behaviors throughout follow-up (P