Machine Learning Algorithms Based on Time Series Pre-Clustering for Nocturnal Glucose Prediction in People with Type 1 Diabetes.

Background: Machine learning offers new options for glucose prediction and real-time glucose management. The aim of this study was to develop a machine learning-based algorithm that takes into account glucose dynamics patterns for predicting nocturnal glucose in individuals with type 1 diabetes. Methods: To identify glucose patterns, we applied a hierarchical clustering algorithm to real-time continuous glucose monitoring data obtained from 570 adult patients. Machine learning algorithms with or without pre-clustering were used for modeling. Results: Eight clusters without nocturnal hypoglycemia and six clusters with at least one low-glucose episode were identified by the cluster analysis. When forecasting time series without hypoglycemia with a prediction horizon (PH) of 15 or 30 min, gradient boosting trees (GBTs) with pre-clustering and random forest (RF) with pre-clustering outperformed algorithms based on medoids of time series clusters, the Holt model, and GBTs without pre-clustering. When forecasting time series with low-glucose episodes, a model based on the pre-clustering and GBTs provided the highest predictive accuracy at PH = 15 min, and a model based on RF with pre-clustering was the best at PH = 30 min. Conclusions: The results indicate that the clustering of glucose dynamics can enhance the efficacy of machine learning algorithms used for glucose prediction.