Valentina Roquemen-Echeverri

arXiv2026

Explainable AI-based Decision Support for Nocturnal Hypoglycemia Prevention in Type 1 Diabetes

Purpose: Nocturnal hypoglycemia (NH) remains a challenge for individuals with type 1 diabetes (T1D), particularly those who are physically active or on multiple daily injections (MDI). We leveraged an explainable evidential neural network model that forecasts minimum overnight glucose to identify NH risk factors and generate recommendations for NH prevention. Methods: We analyzed the impact of glucose and physical activity (PA) factors on predicted NH probability using SHapley Additive exPlanations (SHAP). Data were from 20 adults with T1D on MDI (10 females; mean age 39 years; HbA1c 7\%) who participated in a cross-over study (NCT05967260). Results: A total of 502 nights were analyzed. Bedtime glucose was the strongest predictor of NH. Other relevant factors included recent exposure to high or low glucose, glucose variability before bedtime, and timing of PA. Some associations appeared physiologically counterintuitive, possibly reflecting behavioral adjustments. Based on the identified risk factors and their SHAP values, we determined key decision points and developed recommendations that may help prevent NH, such as consuming a bedtime snack or discussing potential adjustments to insulin therapy with a healthcare provider. Conclusion: Identifying predictors of NH offers insights for managing NH risk in clinical decision support.

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arXiv2025

A Physiologically-Constrained Neural Network Digital Twin Framework for Replicating Glucose Dynamics in Type 1 Diabetes

Simulating glucose dynamics in individuals with type 1 diabetes (T1D) is critical for developing personalized treatments and supporting data-driven clinical decisions. Existing models often miss key physiological aspects and are difficult to individualize. Here, we introduce physiologically-constrained neural network (NN) digital twins to simulate glucose dynamics in T1D. To ensure interpretability and physiological consistency, we first build a population-level NN state-space model aligned with a set of ordinary differential equations (ODEs) describing glucose regulation. This model is formally verified to conform to known T1D dynamics. Digital twins are then created by augmenting the population model with individual-specific models, which include personal data, such as glucose management and contextual information, capturing both inter- and intra-individual variability. We validate our approach using real-world data from the T1D Exercise Initiative study. Two weeks of data per participant were split into 5-hour sequences and simulated glucose profiles were compared to observed ones. Clinically relevant outcomes were used to assess similarity via paired equivalence t-tests with predefined clinical equivalence margins. Across 394 digital twins, glucose outcomes were equivalent between simulated and observed data: time in range (70-180 mg/dL) was 75.1$\pm$21.2% (simulated) vs. 74.4$\pm$15.4% (real; P<0.001); time below range (<70 mg/dL) 2.5$\pm$5.2% vs. 3.0$\pm$3.3% (P=0.022); and time above range (>180 mg/dL) 22.4$\pm$22.0% vs. 22.6$\pm$15.9% (P<0.001). Our framework can incorporate unmodeled factors like sleep and activity while preserving key dynamics. This approach enables personalized in silico testing of treatments, supports insulin optimization, and integrates physics-based and data-driven modeling. Code: https://github.com/mosqueralopez/T1DSim_AI

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