Saman Khamesian

Saman Khamesian, Sri Harini Balaji, Di Yang Shi et al.

Type 1 Diabetes (T1D) management requires continuous adjustment of insulin and lifestyle behaviors to maintain blood glucose within a safe target range. Although automated insulin delivery (AID) systems have improved glycemic outcomes, many patients still fail to achieve recommended clinical targets, warranting new approaches to improve glucose control in patients with T1D. While reinforcement learning (RL) has been utilized as a promising approach, current RL-based methods focus primarily on insulin-only treatment and do not provide behavioral recommendations for glucose control. To address this gap, we propose GUIDE, an RL-based decision-support framework designed to complement AID technologies by providing behavioral recommendations to prevent abnormal glucose events. GUIDE generates structured actions defined by intervention type, magnitude, and timing, including bolus insulin administration and carbohydrate intake events. GUIDE integrates a patient-specific glucose level predictor trained on real-world continuous glucose monitoring data and supports both offline and online RL algorithms within a unified environment. We evaluate both off-policy and on-policy methods across 25 individuals with T1D using standardized glycemic metrics. Among the evaluated approaches, the CQL-BC algorithm demonstrates the highest average time-in-range, reaching 85.49% while maintaining low hypoglycemia exposures. Behavioral similarity analysis further indicates that the learned CQL-BC policy preserves key structural characteristics of patient action patterns, achieving a mean cosine similarity of 0.87 $\pm$ 0.09 across subjects. These findings suggest that conservative offline RL with a structured behavioral action space can provide clinically meaningful and behaviorally plausible decision support for personalized diabetes management.

Saman Khamesian, Asiful Arefeen, Stephanie M. Carpenter et al.

Maintaining a balanced diet is essential for overall health, yet many individuals struggle with meal planning due to nutritional complexity, time constraints, and lack of dietary knowledge. Personalized food recommendations can help address these challenges by tailoring meal plans to individual preferences, habits, and dietary restrictions. However, existing dietary recommendation systems often lack adaptability, fail to consider real-world constraints such as food ingredient availability, and require extensive user input, making them impractical for sustainable and scalable daily use. To address these limitations, we introduce NutriGen, a framework based on large language models (LLM) designed to generate personalized meal plans that align with user-defined dietary preferences and constraints. By building a personalized nutrition database and leveraging prompt engineering, our approach enables LLMs to incorporate reliable nutritional references like the USDA nutrition database while maintaining flexibility and ease-of-use. We demonstrate that LLMs have strong potential in generating accurate and user-friendly food recommendations, addressing key limitations in existing dietary recommendation systems by providing structured, practical, and scalable meal plans. Our evaluation shows that Llama 3.1 8B and GPT-3.5 Turbo achieve the lowest percentage errors of 1.55\% and 3.68\%, respectively, producing meal plans that closely align with user-defined caloric targets while minimizing deviation and improving precision. Additionally, we compared the performance of DeepSeek V3 against several established models to evaluate its potential in personalized nutrition planning.

Saman Khamesian, Asiful Arefeen, Maria Adela Grando et al.

Managing Type 1 Diabetes (T1D) demands constant vigilance as individuals strive to regulate their blood glucose levels to avoid the harmful effects of dysglycemia, including both hyperglycemia and hypoglycemia. Despite the development of advanced technologies such as automated insulin delivery (AID) systems, achieving optimal glycemic control remains challenging. AID systems combine continuous subcutaneous insulin infusion with data from continuous glucose monitors (CGMs), offering potential benefits in reducing glucose variability and increasing time-in-range. However, these systems still frequently fail to prevent dysglycemia, partly due to limitations in their prediction algorithms, which lack the accuracy needed to avert abnormal glucose events. This shortcoming highlights the need for more advanced glucose forecasting methods. To address this need, we introduce GLIMMER, Glucose Level Indicator Model with Modified Error Rate, a machine learning-based model for predicting blood glucose levels. GLIMMER classifies glucose values into normal and abnormal ranges and employs a novel custom loss function that prioritizes accuracy in dysglycemic regions, where patient safety is most critical. To evaluate GLIMMER's effectiveness for T1D management, we used both a publicly available dataset and a newly collected dataset involving 25 individuals with T1D. In forecasting glucose levels for the next hour, GLIMMER achieved a root mean square error (RMSE) of 23.97 (+/-3.77) and a mean absolute error (MAE) of 15.83 (+/-2.09) mg/dL. These results represent a 23% improvement in RMSE and a 31% improvement in MAE compared to the best previously reported models.

Saman Khamesian, Asiful Arefeen, Bithika M. Thompson et al.

High quality real world datasets are essential for advancing data driven approaches in type 1 diabetes (T1D) management, including personalized therapy design, digital twin systems, and glucose prediction models. However, progress in this area has been limited by the scarcity of publicly available datasets that offer detailed and comprehensive patient data. To address this gap, we present AZT1D, a dataset containing data collected from 25 individuals with T1D on automated insulin delivery (AID) systems. AZT1D includes continuous glucose monitoring (CGM) data, insulin pump and insulin administration data, carbohydrate intake, and device mode (regular, sleep, and exercise) obtained over 6 to 8 weeks for each patient. Notably, the dataset provides granular details on bolus insulin delivery (i.e., total dose, bolus type, correction specific amounts) features that are rarely found in existing datasets. By offering rich, naturalistic data, AZT1D supports a wide range of artificial intelligence and machine learning applications aimed at improving clinical decision making and individualized care in T1D.

Asiful Arefeen, Saman Khamesian, Maria Adela Grando et al.

Frequent and long-term exposure to hyperglycemia (i.e., high blood glucose) increases the risk of chronic complications such as neuropathy, nephropathy, and cardiovascular disease. Current technologies like continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) primarily model specific aspects of glycemic control-like hypoglycemia prediction or insulin delivery. Similarly, most digital twin approaches in diabetes management simulate only physiological processes. These systems lack the ability to offer alternative treatment scenarios that support proactive behavioral interventions. To address this, we propose GlyTwin, a novel digital twin framework that uses counterfactual explanations to simulate optimal treatments for glucose regulation. Our approach helps patients and caregivers modify behaviors like carbohydrate intake and insulin dosing to avoid abnormal glucose events. GlyTwin generates behavioral treatment suggestions that proactively prevent hyperglycemia by recommending small adjustments to daily choices, reducing both frequency and duration of these events. Additionally, it incorporates stakeholder preferences into the intervention design, making recommendations patient-centric and tailored. We evaluate GlyTwin on AZT1D, a newly constructed dataset with longitudinal data from 21 type 1 diabetes (T1D) patients on automated insulin delivery systems over 26 days. Results show GlyTwin outperforms state-of-the-art counterfactual methods, generating 76.6% valid and 86% effective interventions. These findings demonstrate the promise of counterfactual-driven digital twins in delivering personalized healthcare.

Saman Khamesian, Hamed Malek

This article presents a "Hybrid Self-Attention NEAT" method to improve the original NeuroEvolution of Augmenting Topologies (NEAT) algorithm in high-dimensional inputs. Although the NEAT algorithm has shown a significant result in different challenging tasks, as input representations are high dimensional, it cannot create a well-tuned network. Our study addresses this limitation by using self-attention as an indirect encoding method to select the most important parts of the input. In addition, we improve its overall performance with the help of a hybrid method to evolve the final network weights. The main conclusion is that Hybrid Self- Attention NEAT can eliminate the restriction of the original NEAT. The results indicate that in comparison with evolutionary algorithms, our model can get comparable scores in Atari games with raw pixels input with a much lower number of parameters.