The Challenge of Predicting Meal-to-meal Blood Glucose Concentrations for Patients with Type I Diabetes

Abstract: Patients with Type I Diabetes (T1D) must take insulin injections to prevent the serious long term effects of hyperglycemia - high blood glucose (BG). Patients must also be careful not to inject too much insulin because this could induce hypoglycemia (low BG), which can potentially be fatal. Patients therefore follow a "regimen" that determines how much insulin to inject at certain times. Current methods for managing this disease require adjusting the patient's regimen over time based on the disease's behavior (recorded in the patient's diabetes diary). If we can accurately predict a patient's future BG values from his/her current features (e.g., predicting today's lunch BG value given today's diabetes diary entry for breakfast, including insulin injections, and perhaps earlier entries), then it is relatively easy to produce an effective regimen. This study explores the challenges of BG modeling by applying several machine learning algorithms and various data preprocessing variations (corresponding to 312 [learner, preprocessed-dataset] combinations), to a new T1D dataset containing 29 601 entries from 47 different patients. Our most accurate predictor is a weighted ensemble of two Gaussian Process Regression models, which achieved an errL1 loss of 2.70 mmol/L (48.65 mg/dl). This was an unexpectedly poor result given that one can obtain an errL1 of 2.91 mmol/L (52.43 mg/dl) using the naive approach of simply predicting the patient's average BG. For each of data-variant/model combination we report several evaluation metrics, including glucose-specific metrics, and find similarly disappointing results (the best model was only incrementally better than the simplest measure). These results suggest that the diabetes diary data that is typically collected may not be sufficient to produce accurate BG prediction models; additional data may be necessary to build accurate BG prediction models.