Implementation of Big Data Analytics for Diabetes Management: Needs Assessment in the Rwanda Healthcare System

Diabetes mellitus affects over 537 million adults worldwide and remains a major challenge in preventive healthcare. Existing machine-learning studies primarily formulate diabetes prediction as a binary classification problem, while subtype-oriented analysis and glycaemic-cognitive associations remain comparatively underexplored. We present a reproducible three-stage machine learning framework for diabetes detection, subtype-oriented clustering, and metabolic-cognitive association analysis. In Stage 1, five supervised classifiers together with a stacking ensemble are benchmarked on the NCSU Diabetes Dataset using stratified five-fold cross-validation and evaluation metrics including ROC-AUC, balanced accuracy, recall, and F1-score. SVM-RBF and Logistic Regression achieve the highest ROC-AUC ($0.825 \pm 0.026$), while Random Forest achieves the highest accuracy ($0.762 \pm 0.030$). SHAP explainability identifies Glucose, BMI, and Age as the dominant predictive biomarkers. In Stage 2, silhouette-validated K-Means clustering ($k=2$, silhouette $\approx 0.116$) is applied to confirmed diabetic cases using Glucose, Insulin, and Age, recovering clinically plausible subtype-oriented partitions without requiring ground-truth subtype labels. In Stage 3, statistical analysis of the Ohio Longitudinal Cognitive Dataset ($n=373$) reveals a significant positive association between glycaemic control and cognitive function ($ρ_s = 0.208$, $p = 5.29 \times 10^{-5}$), which survives Holm correction. The findings support the utility of statistically grounded and interpretable ML pipelines for reproducible diabetes analytics and subtype-aware exploratory analysis.

This paper presents a proof-of-concept digital twin framework for simulation-driven diabetes modeling using benchmark clinical data, synthetic temporal augmentation, and illustrative continuous glucose monitoring (CGM) analysis. Unlike traditional predictive models, the framework focuses on generating interpretable simulated trajectories rather than clinically validated outcomes. Evaluation is conducted using a public dataset combined with controlled synthetic scenarios to illustrate temporal behavior and intervention effects. Results illustrate the feasibility of integrating prediction with counterfactual simulation for decision-aware analysis. This work does not claim clinical readiness but provides a foundation for future research on simulation-driven digital twin systems in healthcare.

Preprocessing blood glucose time-series data is a critical yet often overlooked step in developing data-driven methods for diabetes management, particularly for type 1 diabetes. The lack of standardized preprocessing workflows and evaluation protocols hinders reproducibility and complicates fair comparison across studies. These challenges are further exacerbated by data-sharing restrictions, as privacy and licensing constraints often prevent the redistribution of preprocessed medical datasets. To address these limitations, we present GlucoTune, a comprehensive and extensible framework for reproducible experimentation with blood glucose time-series data. The framework standardizes the entire experimental workflow, from preprocessing to model evaluation, enabling reproducible experiments directly from the original datasets. Reproducible preprocessing is achieved through configurable pipelines defined in portable YAML configuration files, ensuring consistent data handling without distributing sensitive preprocessed data. Beyond preprocessing, GlucoTune provides a unified interface for implementing, training, and evaluating blood glucose prediction models. The framework integrates public datasets through standardized wrappers and provides a curated collection of state-of-the-art blood glucose prediction and general time-series forecasting methods, while remaining readily extensible to additional datasets, preprocessing strategies, and forecasting models. To promote transparent and consistent evaluation, GlucoTune includes a benchmarking leaderboard that reports results across datasets, preprocessing configurations, and forecasting methods, enabling systematic comparison of experimental settings. We demonstrate the effectiveness of GlucoTune through comprehensive experiments and assess its usability in a user study.