hospital diabetes care teams

Abstract: As pretraining scales, medical language models have advanced rapidly in clinical question answering. Their ability to achieve effective physiological control through sustained intervention still lacks systematic quantitative evaluation. Type 1 diabetes provides a concrete setting: impaired insulin secretion creates dependence on exogenous insulin, with dosing continually adjusted using information about meals, exercise, illness, and glucose measurements. We introduce DiabAgent, a research suite for agentic physiological control comprising the Agentic Physiological Control (APC) framework, the DiabetSim simulator, and the SweetBench benchmark. APC controls glucose through medical-device tools, using ongoing observations to infer individual states, accumulate personal experience, and choose treatment actions. We build DiabetSim to simulate different patients, events, and device conditions for scalable virtual testing and training. Using DiabetSim, we construct SweetBench by instantiating 32 scenario designs as 212 glucose-control tasks. With Claude Opus 5.5 and a fixed decision interval of one hour, APC achieves a COGI of 73.5, compared with 71.2 for the open-source closed-loop baseline OpenAPS. Ablations further show that individual adaptation and contextual information improve glucose control. Combining high-frequency rule-based control with lower-frequency agent decisions shows potential for balancing control performance and computational cost. Our work provides a framework, simulator, and evaluation foundation for agents to participate in human physiological control.

Abstract: Anticipating short-term hypoglycemic and hyperglycemic risk is essential for proactive diabetes management. However, existing machine learning approaches often use inconsistent evaluation protocols and emphasize predictive performance over reliability. This study introduces an anchor-based benchmarking framework integrating longitudinal glucose sequences and multimodal patient information. Using the T1DiabetesGranada dataset, 5,503,441 standardized prediction anchors were constructed from 736 individuals with type 1 diabetes to evaluate hypoglycemia and hyperglycemia prediction at 30-, 60-, and 120-minute horizons. Three neural architectures, a Hybrid LSTM-Transformer, a Multimodal Digital Twin, and a State-Updating Digital Twin with gap-aware longitudinal state progression, were compared under identical patient-level validation protocols. Beyond predictive performance, the evaluation examined calibration, classification thresholds, explanation reliability, cross-model disagreement, and robustness to controlled perturbations. No statistically significant predictive differences were observed after Holm correction, although the models exhibited complementary reliability characteristics. The Multimodal Digital Twin achieved the lowest mean Brier score, while the State-Updating Digital Twin demonstrated the lowest mean expected calibration error (ECE-10). The Hybrid LSTM-Transformer showed strong explanation faithfulness and stability under its temporal attribution protocol. These findings highlight the importance of evaluating digital-twin models beyond predictive accuracy and emphasize the need for reliability assessment and external validation before clinical deployment.