Integrated image-based deep learning and language models for primary diabetes care
Jiajia LiShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, ChinaZhouyu GuanShanghai Sixth People's HospitalJing WangHuadong SanatoriumCarol Y. CheungDepartment of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, ChinaYingfeng ZhengState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, ChinaLee‐Ling LimDepartment of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, MalaysiaCynthia Ciwei LimSingapore General HospitalPaisan RuamviboonsukRangsit UniversityRajiv RamanShri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, IndiaLeonor CorsinoDepartment of Medicine, Division of Endocrinology, Metabolism and Nutrition, and Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USAJustin B. Echouffo‐TcheuguiDepartment of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USAAndrea O. Y. LukDepartment of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, ChinaLi Jia ChenDepartment of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, ChinaXiaodong SunShanghai First People's HospitalHaslina HamzahSingapore Eye Research InstituteQiang WuDepartment of Ophthalmology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaXiangning WangDepartment of Ophthalmology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaRuhan LiuMOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, ChinaYa Xing WangBeijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, ChinaTing‐Li ChenDepartment of Ophthalmology, Huadong Sanatorium, Wuxi, ChinaXiao ZhangXiaolong YangDepartment of Ophthalmology, Huadong Sanatorium, Wuxi, ChinaJun YinShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, ChinaJing WanDepartment of Ophthalmology, Huadong Sanatorium, Wuxi, ChinaDu WeiDepartment of Endocrinology and Metabolism, Shanghai Eighth People's Hospital, Shanghai, ChinaTen Cheer QuekSingapore Eye Research Institute, Singapore National Eye Centre, Singapore, SingaporeJocelyn Hui Lin GohSingapore Eye Research Institute, Singapore National Eye Centre, Singapore, SingaporeDawei YangDepartment of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, ChinaXiaoyan HuDepartment of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, ChinaTruong NguyenDepartment of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, ChinaSimon SzetoDepartment of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, ChinaPeranut ChotcomwongseFaculty of Medicine, Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, ThailandRachid MalekDepartment of Internal Medicine, Setif University Ferhat Abbas, Setif, AlgeriaNargiza NormatovaOphthalmology Department at Tashkent Advanced Training Institute for Doctors, Tashkent, UzbekistanNilufar IbragimovaRamyaa SrinivasanShri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, IndiaPingting ZhongState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, ChinaWenyong HuangState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, ChinaChenxin DengHuazhong University of Science and TechnologyLei RuanHuazhong University of Science and TechnologyCuntai ZhangHuazhong University of Science and TechnologyChenxi ZhangDepartment of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, ChinaYan ZhouPeking Union Medical College HospitalChan WuPeking Union Medical College HospitalRongping DaiPeking Union Medical College HospitalSky Wei Chee KohNational University Health SystemAdina AbdullahDepartment of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MalaysiaNicholas Ken Yoong HeeDepartment of Medicine, University Malaya Medical Centre, Kuala Lumpur, MalaysiaHong Chang TanDepartment of Endocrinology, Singapore General Hospital, Singapore, SingaporeZhong Hong LiewSingapore General HospitalCarolyn Shan‐Yeu TienDepartment of Renal Medicine, Singapore General Hospital, SingHealth-Duke Academic Medical Centre, Singapore, SingaporeShih Ling KaoDivision of Endocrinology, University Medicine Cluster, National University Health System, Singapore, SingaporeAmanda Yuan Ling LimDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeShao Feng MokDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeLina SunDepartment of Internal Medicine, Huadong Sanatorium, Wuxi, ChinaJing GuHuadong SanatoriumLiang WuShanghai Sixth People's HospitalTingyao LiShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, ChinaDi ChengShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, ChinaZheyuan WangShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, ChinaYiming QinMOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, ChinaLing DaiShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, ChinaZiyao MengMOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, ChinaJia ShuMOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, ChinaYuwei LuShanghai Sixth People's HospitalNan JiangShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, ChinaTingting HuShanghai Sixth People's HospitalShan HuangMOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, ChinaGengyou HuangShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, ChinaShujie YuShanghai Sixth People's HospitalDan LiuShanghai Sixth People's HospitalWeizhi MaInstitute for AI Industry Research, Tsinghua University, Beijing, ChinaMinyi GuoShanghai Sixth People's HospitalXinping GuanDepartment of Automation and the Key Laboratory of System Control and Information Processing, Ministry of Education of China, Shanghai Jiao Tong University, Shanghai, ChinaXiaokang YangMOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, ChinaCovadonga BascaránLondon School of Hygiene & Tropical MedicineCharles R ClelandInternational Centre for Eye Health, London School of Hygiene and Tropical Medicine, University of London, London, UKYuqian BaoShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, ChinaElif I. EkinciDepartment of Endocrinology, Austin Health, Melbourne, Victoria, AustraliaAlicia J. JenkinsAustralian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Parkville, Victoria, AustraliaJuliana C.N. ChanDepartment of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, ChinaYong Mong BeeDepartment of Endocrinology, Singapore General Hospital, Singapore, SingaporeSobha SivaprasadNIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UKJonathan E. ShawAustin HealthRafael SimóDiabetes and Metabolism Research Unit, Vall d'Hebron Research Institut, Autonomous University of Barcelona, Barcelona, SpainPearse A. KeaneUniversity College LondonChing‐Yu ChengSingapore Eye Research Institute, Singapore National Eye Centre, Singapore, SingaporeGavin Siew Wei TanSingapore Eye Research InstituteWeiping JiaShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, ChinaYih Chung ThamOphthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore. [email protected]Huating LiShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China. [email protected]Bin ShengShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China. [email protected]Tien Yin WongSingapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. [email protected]
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Primary diabetes care and diabetic retinopathy (DR) screening persist as major public health challenges due to a shortage of trained primary care physicians (PCPs), particularly in low-resource settings. Here, to bridge the gaps, we developed an integrated image-language system (DeepDR-LLM), combining a large language model (LLM module) and image-based deep learning (DeepDR-Transformer), to provide individualized diabetes management recommendations to PCPs. In a retrospective evaluation, the LLM module demonstrated comparable performance to PCPs and endocrinology residents when tested in English and outperformed PCPs and had comparable performance to endocrinology residents in Chinese. For identifying referable DR, the average PCP's accuracy was 81.0% unassisted and 92.3% assisted by DeepDR-Transformer. Furthermore, we performed a single-center real-world prospective study, deploying DeepDR-LLM. We compared diabetes management adherence of patients under the unassisted PCP arm (n = 397) with those under the PCP+DeepDR-LLM arm (n = 372). Patients with newly diagnosed diabetes in the PCP+DeepDR-LLM arm showed better self-management behaviors throughout follow-up (P < 0.05). For patients with referral DR, those in the PCP+DeepDR-LLM arm were more likely to adhere to DR referrals (P < 0.01). Additionally, DeepDR-LLM deployment improved the quality and empathy level of management recommendations. Given its multifaceted performance, DeepDR-LLM holds promise as a digital solution for enhancing primary diabetes care and DR screening.
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