Comorbid chronic conditions are common among people with type 2 diabetes. We developed an Artificial Intelligence algorithm, based on Reinforcement Learning (RL), for personalized diabetes and multi-morbidity management with strong potential to improve health outcomes relative to current clinical practice. In this paper, we modeled glycemia, blood pressure and cardiovascular disease (CVD) risk as health outcomes using a retrospective cohort of 16,665 patients with type 2 diabetes from New York University Langone Health ambulatory care electronic health records in 2009 to 2017. We trained a RL prescription algorithm that recommends a treatment regimen optimizing patients' cumulative health outcomes using their individual characteristics and medical history at each encounter. The RL recommendations were evaluated on an independent subset of patients. The results demonstrate that the proposed personalized reinforcement learning prescriptive framework for type 2 diabetes yielded high concordance with clinicians' prescriptions and substantial improvements in glycemia, blood pressure, cardiovascular disease risk outcomes.
Patient-Centered Treatment Planning for Chronic Multimorbidity: A Hierarchical Reinforcement Learning Framework for Preference Modeling
University of Tennessee, Knoxville（田纳西大学诺克斯维尔分校）；University of Tennessee Health Science Center College of Medicine（田纳西大学健康科学中心医学院）；University of Tennessee Medical Center（田纳西大学医学中心）；University of Arkansas（阿肯色大学）
Rambam Health Care Campus（兰巴姆医疗园区）；Technion, Israel Institute of Technology（以色列理工学院）；Microsoft Research（微软研究院）
Regular physical activity is known to be beneficial to people suffering from diabetes type 2. Nevertheless, most such people are sedentary. Smartphones create new possibilities for helping people to adhere to their physical activity goals, through continuous monitoring and communication, coupled with personalized feedback. We provided 27 sedentary diabetes type 2 patients with a smartphone-based pedometer and a personal plan for physical activity. Patients were sent SMS messages to encourage physical activity between once a day and once per week. Messages were personalized through a Reinforcem…
We propose a dual-hormone delivery strategy by exploiting deep reinforcement learning (RL) for people with Type 1 Diabetes (T1D). Specifically, double dilated recurrent neural networks (RNN) are used to learn the hormone delivery strategy, trained by a variant of Q-learning, whose inputs are raw data of glucose \& meal carbohydrate and outputs are dual-hormone (insulin and glucagon) delivery. Without prior knowledge of the glucose-insulin metabolism, we run the method on the UVA/Padova simulator. Hundreds days of self-play are performed to obtain a generalized model, then importance sampling i…
GUIDE: Reinforcement Learning for Behavioral Action Support in Type 1 Diabetes
College of Health Solutions, Arizona State University（亚利桑那州立大学健康解决方案学院）；School of Computing and Augmented Intelligence, Arizona State University（亚利桑那州立大学计算与增强智能学院）；School for Engineering of Matter Transport and Energy, Arizona State University（亚利桑那州立大学物质传输与能源工程学院）；Institute for Foundation of Machine Learning, The University of Texas at Austin（德克萨斯大学奥斯汀分校机器学习基础研究所）；Sony AI（索尼人工智能）
Imperial College London（伦敦帝国学院）；University College London（伦敦大学学院）
People with Type 1 diabetes (T1D) require regular exogenous infusion of insulin to maintain their blood glucose concentration in a therapeutically adequate target range. Although the artificial pancreas and continuous glucose monitoring have been proven to be effective in achieving closed-loop control, significant challenges still remain due to the high complexity of glucose dynamics and limitations in the technology. In this work, we propose a novel deep reinforcement learning model for single-hormone (insulin) and dual-hormone (insulin and glucagon) delivery. In particular, the delivery stra…
Dynamic treatment regimes (DTRs) are personalized, adaptive, multi-stage treatment plans that adapt treatment decisions both to an individual's initial features and to intermediate outcomes and features at each subsequent stage, which are affected by decisions in prior stages. Examples include personalized first- and second-line treatments of chronic conditions like diabetes, cancer, and depression, which adapt to patient response to first-line treatment, disease progression, and individual characteristics. While existing literature mostly focuses on estimating the optimal DTR from offline dat…
North Carolina State University（北卡罗来纳州立大学）；London School of Economics and Political Science（伦敦政治经济学院）
Dynamic treatment regimes assign personalized treatments to patients sequentially over time based on their baseline information and time-varying covariates. In mobile health applications, these covariates are typically collected at different frequencies over a long time horizon. In this paper, we propose a deep spectral Q-learning algorithm, which integrates principal component analysis (PCA) with deep Q-learning to handle the mixed frequency data. In theory, we prove that the mean return under the estimated optimal policy converges to that under the optimal one and establish its rate of conve…
Finding an optimal individualized treatment regimen is considered one of the most challenging precision medicine problems. Various patient characteristics influence the response to the treatment, and hence, there is no one-size-fits-all regimen. Moreover, the administration of an unsafe dose during the treatment can have adverse effects on health. Therefore, a treatment model must ensure patient \emph{safety} while \emph{efficiently} optimizing the course of therapy. We study a prevalent medical problem where the treatment aims to keep a physiological variable in a safe range and preferably cl…
Many sequential decision-making tasks require choosing at each decision step the right action out of the vast set of possibilities by extracting actionable intelligence from high-dimensional data streams. Most of the times, the high-dimensionality of actions and data makes learning of the optimal actions by traditional learning methods impracticable. In this work, we investigate how to discover and leverage sparsity in actions and data to enable fast learning. As our learning model, we consider a structured contextual multi-armed bandit (CMAB) with high-dimensional arm (action) and context (da…
Hybrid Control Policy for Artificial Pancreas via Ensemble Deep Reinforcement Learning
East China University of Science and Technology（华东理工大学）；Shanghai Jiao Tong University Affiliated Sixth People’s Hospital（上海交通大学附属第六人民医院）；Shanghai Diabetes Institute（上海市糖尿病研究所）；Shanghai Clinical Center for Diabetes（上海市糖尿病临床医学中心）
Effective patient education is critical for managing Type 2 Diabetes Mellitus (T2DM), one of the most common chronic diseases in the United States. While some studies focus on the information-seeking behavior of T2DM patients, other self-education behaviors including information processing and utilization are rarely explored in the context of T2DM. This study sought to assess two self-education behaviors of type 2 diabetics, namely, information seeking and information processing, to understand more about how these behaviors affect the self-management of this common chronic disease. Semi-struct…
