Simulating Clinical AI Assistance using Multimodal LLMs: A Case Study in Diabetic Retinopathy

Diabetic retinopathy (DR) is a leading cause of blindness worldwide, and AI systems can expand access to fundus photography screening. Current FDA-cleared systems primarily provide binary referral outputs, where this minimal output may limit clinical trust and utility. Yet, determining the most effective output format to enhance clinician-AI performance is an empirical challenge that is difficult to assess at scale. We evaluated multimodal large language models (MLLMs) for DR detection and their ability to simulate clinical AI assistance across different output types. Two models were tested on IDRiD and Messidor-2: GPT-4o, a general-purpose MLLM, and MedGemma, an open-source medical model. Experiments included: (1) baseline evaluation, (2) simulated AI assistance with synthetic predictions, and (3) actual AI-to-AI collaboration where GPT-4o incorporated MedGemma outputs. MedGemma outperformed GPT-4o at baseline, achieving higher sensitivity and AUROC, while GPT-4o showed near-perfect specificity but low sensitivity. Both models adjusted predictions based on simulated AI inputs, but GPT-4o's performance collapsed with incorrect ones, whereas MedGemma remained more stable. In actual collaboration, GPT-4o achieved strong results when guided by MedGemma's descriptive outputs, even without direct image access (AUROC up to 0.96). These findings suggest MLLMs may improve DR screening pipelines and serve as scalable simulators for studying clinical AI assistance across varying output configurations. Open, lightweight models such as MedGemma may be especially valuable in low-resource settings, while descriptive outputs could enhance explainability and clinician trust in clinical workflows.

Effect of Data Augmentation on Conformal Prediction for Diabetic Retinopathy

The clinical deployment of deep learning models for high-stakes tasks such as diabetic retinopathy (DR) grading requires demonstrable reliability. While models achieve high accuracy, their clinical utility is limited by a lack of robust uncertainty quantification. Conformal prediction (CP) offers a distribution-free framework to generate prediction sets with statistical guarantees of coverage. However, the interaction between standard training practices like data augmentation and the validity of these guarantees is not well understood. In this study, we systematically investigate how different data augmentation strategies affect the performance of conformal predictors for DR grading. Using the DDR dataset, we evaluate two backbone architectures -- ResNet-50 and a Co-Scale Conv-Attentional Transformer (CoaT) -- trained under five augmentation regimes: no augmentation, standard geometric transforms, CLAHE, Mixup, and CutMix. We analyze the downstream effects on conformal metrics, including empirical coverage, average prediction set size, and correct efficiency. Our results demonstrate that sample-mixing strategies like Mixup and CutMix not only improve predictive accuracy but also yield more reliable and efficient uncertainty estimates. Conversely, methods like CLAHE can negatively impact model certainty. These findings highlight the need to co-design augmentation strategies with downstream uncertainty quantification in mind to build genuinely trustworthy AI systems for medical imaging.

PRISM: A Framework Harnessing Unsupervised Visual Representations and Textual Prompts for Explainable MACE Survival Prediction from Cardiac Cine MRI

Accurate prediction of major adverse cardiac events (MACE) remains a central challenge in cardiovascular prognosis. We present PRISM (Prompt-guided Representation Integration for Survival Modeling), a self-supervised framework that integrates visual representations from non-contrast cardiac cine magnetic resonance imaging with structured electronic health records (EHRs) for survival analysis. PRISM extracts temporally synchronized imaging features through motion-aware multi-view distillation and modulates them using medically informed textual prompts to enable fine-grained risk prediction. Across four independent clinical cohorts, PRISM consistently surpasses classical survival prediction models and state-of-the-art (SOTA) deep learning baselines under internal and external validation. Further clinical findings demonstrate that the combined imaging and EHR representations derived from PRISM provide valuable insights into cardiac risk across diverse cohorts. Three distinct imaging signatures associated with elevated MACE risk are uncovered, including lateral wall dyssynchrony, inferior wall hypersensitivity, and anterior elevated focus during diastole. Prompt-guided attribution further identifies hypertension, diabetes, and smoking as dominant contributors among clinical and physiological EHR factors.

Glucose-ML: A collection of longitudinal diabetes datasets for development of robust AI solutions

Artificial intelligence (AI) algorithms are a critical part of state-of-the-art digital health technology for diabetes management. Yet, access to large high-quality datasets is creating barriers that impede development of robust AI solutions. To accelerate development of transparent, reproducible, and robust AI solutions, we present Glucose-ML, a collection of 10 publicly available diabetes datasets, released within the last 7 years (i.e., 2018 - 2025). The Glucose-ML collection comprises over 300,000 days of continuous glucose monitor (CGM) data with a total of 38 million glucose samples collected from 2500+ people across 4 countries. Participants include persons living with type 1 diabetes, type 2 diabetes, prediabetes, and no diabetes. To support researchers and innovators with using this rich collection of diabetes datasets, we present a comparative analysis to guide algorithm developers with data selection. Additionally, we conduct a case study for the task of blood glucose prediction - one of the most common AI tasks within the field. Through this case study, we provide a benchmark for short-term blood glucose prediction across all 10 publicly available diabetes datasets within the Glucose-ML collection. We show that the same algorithm can have significantly different prediction results when developed/evaluated with different datasets. Findings from this study are then used to inform recommendations for developing robust AI solutions within the diabetes or broader health domain. We provide direct links to each longitudinal diabetes dataset in the Glucose-ML collection and openly provide our code.

From Chat to Checkup: Can Large Language Models Assist in Diabetes Prediction?

While Machine Learning (ML) and Deep Learning (DL) models have been widely used for diabetes prediction, the use of Large Language Models (LLMs) for structured numerical data is still not well explored. In this study, we test the effectiveness of LLMs in predicting diabetes using zero-shot, one-shot, and three-shot prompting methods. We conduct an empirical analysis using the Pima Indian Diabetes Database (PIDD). We evaluate six LLMs, including four open-source models: Gemma-2-27B, Mistral-7B, Llama-3.1-8B, and Llama-3.2-2B. We also test two proprietary models: GPT-4o and Gemini Flash 2.0. In addition, we compare their performance with three traditional machine learning models: Random Forest, Logistic Regression, and Support Vector Machine (SVM). We use accuracy, precision, recall, and F1-score as evaluation metrics. Our results show that proprietary LLMs perform better than open-source ones, with GPT-4o and Gemma-2-27B achieving the highest accuracy in few-shot settings. Notably, Gemma-2-27B also outperforms the traditional ML models in terms of F1-score. However, there are still issues such as performance variation across prompting strategies and the need for domain-specific fine-tuning. This study shows that LLMs can be useful for medical prediction tasks and encourages future work on prompt engineering and hybrid approaches to improve healthcare predictions.

Diabetes Prediction and Management Using Machine Learning Approaches

Diabetes has emerged as a significant global health issue, especially with the increasing number of cases in many countries. This trend Underlines the need for a greater emphasis on early detection and proactive management to avert or mitigate the severe health complications of this disease. Over recent years, machine learning algorithms have shown promising potential in predicting diabetes risk and are beneficial for practitioners. Objective: This study highlights the prediction capabilities of statistical and non-statistical machine learning methods over Diabetes risk classification in 768 samples from the Pima Indians Diabetes Database. It consists of the significant demographic and clinical features of age, body mass index (BMI) and blood glucose levels that greatly depend on the vulnerability against Diabetes. The experimentation assesses the various types of machine learning algorithms in terms of accuracy and effectiveness regarding diabetes prediction. These algorithms include Logistic Regression, Decision Tree, Random Forest, K-Nearest Neighbors, Naive Bayes, Support Vector Machine, Gradient Boosting and Neural Network Models. The results show that the Neural Network algorithm gained the highest predictive accuracy with 78,57 %, and then the Random Forest algorithm had the second position with 76,30 % accuracy. These findings show that machine learning techniques are not just highly effective. Still, they also can potentially act as early screening tools in predicting Diabetes within a data-driven fashion with valuable information on who is more likely to get affected. In addition, this study can help to realize the potential of machine learning for timely intervention over the longer term, which is a step towards reducing health outcomes and disease burden attributable to Diabetes on healthcare systems

Lightweight Sequential Transformers for Blood Glucose Level Prediction in Type-1 Diabetes

Type 1 Diabetes (T1D) affects millions worldwide, requiring continuous monitoring to prevent severe hypo- and hyperglycemic events. While continuous glucose monitoring has improved blood glucose management, deploying predictive models on wearable devices remains challenging due to computational and memory constraints. To address this, we propose a novel Lightweight Sequential Transformer model designed for blood glucose prediction in T1D. By integrating the strengths of Transformers' attention mechanisms and the sequential processing of recurrent neural networks, our architecture captures long-term dependencies while maintaining computational efficiency. The model is optimized for deployment on resource-constrained edge devices and incorporates a balanced loss function to handle the inherent data imbalance in hypo- and hyperglycemic events. Experiments on two benchmark datasets, OhioT1DM and DiaTrend, demonstrate that the proposed model outperforms state-of-the-art methods in predicting glucose levels and detecting adverse events. This work fills the gap between high-performance modeling and practical deployment, providing a reliable and efficient T1D management solution.

Federated Learning for MRI-based BrainAGE: a multicenter study on post-stroke functional outcome prediction

$\textbf{Objective:}$ Brain-predicted age difference (BrainAGE) is a neuroimaging biomarker reflecting brain health. However, training robust BrainAGE models requires large datasets, often restricted by privacy concerns. This study evaluates the performance of federated learning (FL) for BrainAGE estimation in ischemic stroke patients treated with mechanical thrombectomy, and investigates its association with clinical phenotypes and functional outcomes. $\textbf{Methods:}$ We used FLAIR brain images from 1674 stroke patients across 16 hospital centers. We implemented standard machine learning and deep learning models for BrainAGE estimates under three data management strategies: centralized learning (pooled data), FL (local training at each site), and single-site learning. We reported prediction errors and examined associations between BrainAGE and vascular risk factors (e.g., diabetes mellitus, hypertension, smoking), as well as functional outcomes at three months post-stroke. Logistic regression evaluated BrainAGE's predictive value for these outcomes, adjusting for age, sex, vascular risk factors, stroke severity, time between MRI and arterial puncture, prior intravenous thrombolysis, and recanalisation outcome. $\textbf{Results:}$ While centralized learning yielded the most accurate predictions, FL consistently outperformed single-site models. BrainAGE was significantly higher in patients with diabetes mellitus across all models. Comparisons between patients with good and poor functional outcomes, and multivariate predictions of these outcomes showed the significance of the association between BrainAGE and post-stroke recovery. $\textbf{Conclusion:}$ FL enables accurate age predictions without data centralization. The strong association between BrainAGE, vascular risk factors, and post-stroke recovery highlights its potential for prognostic modeling in stroke care.

Can Copulas Be Used for Feature Selection? A Machine Learning Study on Diabetes Risk Prediction

Accurate diabetes risk prediction relies on identifying key features from complex health datasets, but conventional methods like mutual information (MI) filters and genetic algorithms (GAs) often overlook extreme dependencies critical for high-risk subpopulations. In this study we introduce a feature-selection framework using the upper-tail dependence coefficient ({\lambda}U) of the novel A2 copula, which quantifies how often extreme higher values of a predictor co-occur with diabetes diagnoses (target variable). Applied to the CDC Diabetes Health Indicators dataset (n=253,680), our method prioritizes five predictors (self-reported general health, high blood pressure, body mass index, mobility limitations, and high cholesterol levels) based on upper tail dependencies. These features match or outperform MI and GA selected subsets across four classifiers (Random Forest, XGBoost, Logistic Regression, Gradient Boosting), achieving accuracy up to 86.5% (XGBoost) and AUC up to 0.806 (Gradient Boosting), rivaling the full 21-feature model. Permutation importance confirms clinical relevance, with BMI and general health driving accuracy. To our knowledge, this is the first work to apply a copula's upper-tail dependence for supervised feature selection, bridging extreme-value theory and machine learning to deliver a practical toolkit for diabetes prevention.

Predicting Diabetes Using Machine Learning: A Comparative Study of Classifiers

Diabetes remains a significant health challenge globally, contributing to severe complications like kidney disease, vision loss, and heart issues. The application of machine learning (ML) in healthcare enables efficient and accurate disease prediction, offering avenues for early intervention and patient support. Our study introduces an innovative diabetes prediction framework, leveraging both traditional ML techniques such as Logistic Regression, SVM, Na\"ive Bayes, and Random Forest and advanced ensemble methods like AdaBoost, Gradient Boosting, Extra Trees, and XGBoost. Central to our approach is the development of a novel model, DNet, a hybrid architecture combining Convolutional Neural Network (CNN) and Long Short-Term Memory (LSTM) layers for effective feature extraction and sequential learning. The DNet model comprises an initial convolutional block for capturing essential features, followed by a residual block with skip connections to facilitate efficient information flow. Batch Normalization and Dropout are employed for robust regularization, and an LSTM layer captures temporal dependencies within the data. Using a Kaggle-sourced real-world diabetes dataset, our model evaluation spans cross-validation accuracy, precision, recall, F1 score, and ROC-AUC. Among the models, DNet demonstrates the highest efficacy with an accuracy of 99.79% and an AUC-ROC of 99.98%, establishing its potential for superior diabetes prediction. This robust hybrid architecture showcases the value of combining CNN and LSTM layers, emphasizing its applicability in medical diagnostics and disease prediction tasks.