Let Curves Speak: A Continuous Glucose Monitor based Large Sensor Foundation Model for Diabetes Management

While previous studies of AI in diabetes management focus on long-term risk, research on near-future glucose prediction remains limited but important as it enables timely diabetes self-management. Integrating AI with continuous glucose monitoring (CGM) holds promise for near-future glucose prediction. However, existing models have limitations in capturing patterns of blood glucose fluctuations and demonstrate poor generalizability. A robust approach is needed to leverage massive CGM data for near-future glucose prediction. We propose large sensor models (LSMs) to capture knowledge in CGM data by modeling patients as sequences of glucose. CGM-LSM is pretrained on 15.96 million glucose records from 592 diabetes patients for near-future glucose prediction. We evaluated CGM-LSM against state-of-the-art methods using the OhioT1DM dataset across various metrics, prediction horizons, and unseen patients. Additionally, we assessed its generalizability across factors like diabetes type, age, gender, and hour of day. CGM-LSM achieved exceptional performance, with an rMSE of 29.81 mg/dL for type 1 diabetes patients and 23.49 mg/dL for type 2 diabetes patients in a two-hour prediction horizon. For the OhioT1DM dataset, CGM-LSM achieved a one-hour rMSE of 15.64 mg/dL, halving the previous best of 31.97 mg/dL. Robustness analyses revealed consistent performance not only for unseen patients and future periods, but also across diabetes type, age, and gender. The model demonstrated adaptability to different hours of day, maintaining accuracy across periods of various activity intensity levels. CGM-LSM represents a transformative step in diabetes management by leveraging pretraining to uncover latent glucose generation patterns in sensor data. Our findings also underscore the broader potential of LSMs to drive innovation across domains involving complex sensor data.