Interpretable time-series neural turing machine for prognostic prediction of patients with type 2 diabetes in physician-pharmacist collaborative clinics.

Background: Type 2 diabetes (T2D) has become a serious health threat globally. However, the existing approaches for diabetes prediction mainly had difficulty in addressing multiple time-series features. This study aims to provide an adjunctive tool for the clinical identification of patients in physician-pharmacist collaborative clinics at high risk of poor prognosis.

Methods: This study proposes a novel interpretable time-series Neural Turing Machine (ITS-NTM) to form patient characteristics into feature matrixes to simulate one's disease and treatment process, predicting the prognosis of patients with T2D and alerting early interventions. Model robustness was verified by 10-fold cross-validation, external validation and multi-model comparisons. We also conducted dynamic prediction and feature importance analysis to explore its interpretability.

Results: The study population included patients with T2D attending physician-pharmacist collaborative clinics over 12 months in primary healthcare centers, while clinical features and behavioral indicators at baseline, 3rd, 6th, 9th and 12th months were used to reflect the fluctuation of disease control over time. Compared with five state-of-the-art prediction models, the ITS-NTM obtains 92.0 % in accuracy and 91.8 % F1-score, demonstrating the superiority performance. Feature importance demonstrated that the top 5 features were glycosylated hemoglobin, fasting blood glucose, medication adherence scores, 2-hour postprandial blood glucose and waist-to-hip ratio, which had the greatest impact on the performance of the predictive model.

Conclusions: Proposed ITS-NTM could be used to promote the implementation of physician-pharmacist collaborative clinics, and further prompt the application of artificial intelligence to optimize the allocation of medical resources and improve the quality of care in under-resourced areas.