PACD-Net: Pseudo-Augmented Contrastive Distillation for Glycemic Control Estimation from SMBG
Authors: Canyu Lei, David Repaske, Jianxin Xie
Organizations: University of Virginia, School of Data Science, Charlottesville, VA 22903, USA · University of Virginia, Department of Pediatrics, Charlottesville, VA 22903, USA
Effective diabetes management requires continuous monitoring of glycemic levels. Clinically, glycemic control is assessed using metrics such as Time in Range (TIR), Time Below Range (TBR), and Time Above Range (TAR), typically derived from continuous glucose monitoring (CGM). However, many patients rely on self-monitoring of blood glucose (SMBG) due to the high cost and limited accessibility of CGM. Unlike CGM, SMBG provides sparse and irregular measurements, making accurate estimation of these metrics challenging. Conventional supervised learning approaches struggle under such sparsity, leading to poor generalization and unstable performance. To address this, we propose PACD-Net, a self-supervised contrastive knowledge distillation framework for estimating glycemic control from SMBG. Pseudo-SMBG samples with richer temporal coverage are used as teacher signals to guide learning from sparse observations. In addition, multi-view contrastive learning enforces representation consistency across diverse sampling patterns. The model adopts a hybrid Swin Transformer-CNN backbone to capture temporal dependencies in sparse SMBG sequences. Experimental results demonstrate that PACD-Net consistently outperforms existing methods in estimating TAR, TIR, and TBR from real-world SMBG data, achieving improved accuracy as well as enhanced stability and generalization under extremely sparse observation settings. The proposed framework provides a practical tool for clinical SMBG interpretation and offers a generalizable approach for learning from sparse and irregularly sampled sensor data in broader applications.
Accurate forecasting of blood glucose concentration is key in the management of Type 1 Diabetes, facilitating early detection of adverse glycemic events and supporting timely therapeutic interventions. Despite recent advances in glucose prediction, most existing approaches rely on population-level representations or implicit personalization strategies that fail to deliver effective subject-specific forecasts. In this work, we propose Subject-Conditioned Glucose Prediction (SCGP), a novel multimodal deep learning architecture conceived for personalized blood glucose prediction. SCGP conditions glucose predictions based on observed glucose data and a compact subject-specific representation learned from contextual information. By explicitly separating subject characterization from glucose dynamics modeling and avoiding early fusion of heterogeneous inputs, the proposed framework effectively captures inter-subject variability while preserving robust and reliable temporal modeling. Experiments on two state-of-the-art benchmark datasets demonstrate that SCGP consistently improves forecasting performance, enabling reliable detection of adverse glycemic events across multiple prediction horizons, highlighting the benefits of explicit subject conditioning for personalized diabetes management.
Giorgia Rigamonti, Mirko Paolo Barbato, Davide Marelli +1
Continuous glucose monitoring (CGM) provides a dense view of daily metabolic physiology, yet existing generic time-series and CGM-specific foundation models often encode glucose traces as entangled single-stream sequences, leaving the distinct temporal structure of glycemic dynamics only implicitly modeled. We present GlucoFM, a lightweight CGM foundation model that aligns irregular recordings to a 24-hour chronological grid, preserves observation masks, and decomposes glucose dynamics into slow physiological state and transient event streams, capturing low-frequency glycemic baselines and short-term deviations that may reflect acute physiological responses or sensor artifacts. GlucoFM is pretrained on 109,066 hours of unlabeled CGM recordings from 477 subjects with two complementary objectives: masked contextual latent prediction over fused daily representations and temporal dynamics prediction over state and event streams. Across four diverse cohorts and seven clinical prediction tasks, GlucoFM achieves the strongest subject-disjoint linear-probing performance among evaluated baselines, improving average PR-AUC by 4.1 points over the best CGM-specific foundation model. Its gains are most pronounced on core metabolic outcomes, leading PR-AUC on all diabetes-risk and β-cell dysfunction tasks and on 3 of 4 insulin-resistance tasks. GlucoFM also achieves the best overall cross-dataset transfer performance and strong few-shot adaptation among evaluated methods, and consistent gains when aggregating multiple days for subject-level prediction, highlighting physiology-aware decomposition as an effective inductive bias for transferable CGM representation learning.
Accurate blood glucose forecasting using continuous glucose monitoring (CGM) data can support the early prediction of dysglycemic risk. However, current neural-network-based forecasting models treat CGM data as a purely numerical sequence without integrating the contextual information contained in CGM signal morphology. Recently, large language models (LLMs) have shown promise for time-series forecasting, yet their role as agentic context extractors in diabetes care remains largely unexplored. In this study, we bridge glucose forecasting and LLM-based contextualization by developing GlyRAG, a context-aware, retrieval-augmented forecasting framework that uses an LLM as a contextualization agent to summarize glucose morphology directly from a timed CGM window. The generated CGM-only narrative is embedded and fused with patch-based glucose representations, while a retrieval module incorporates similar historical training episodes through cross-attention. We evaluate GlyRAG on the OhioT1DM and AZT1D datasets for 5-, 30-, and 60-minute forecasting horizons. Compared with strong CGM-only baselines, GPT-4 GlyRAG significantly improves long-horizon root mean square error (RMSE) over PatchTST on both datasets. For example, RMSE decreases from 13.8 to 10.6 at 30 minutes and from 23.1 to 20.2 at 60 minutes on OhioT1DM. LLaMA 3.1 produces smaller but significant long-horizon gains, suggesting that the contextualization pipeline is not limited to GPT-4. Clinical error-grid analyses further show that approximately 85 percent of predictions fall within the clinically acceptable Clarke Error Grid Zones A and B. These results suggest that CGM-derived linguistic context and case-based retrieval can improve long-horizon glucose forecasting without requiring additional sensing modalities.