Artificial intelligence-driven clinical decision support systems to assist healthcare professionals and people with diabetes in Europe at the point of care: a Delphi-based consensus roadmap

The use of artificial intelligence (AI) to improve the diagnosis, assessment and treatment of people with diabetes has the potential to drive a paradigm shift in diabetes care, both minimising treatment inertia and optimising clinical outcomes. This is a significant opportunity, given the predicted increase in the burden of diabetes over the next 20 years. However, there are concerns that regulatory processes for development and implementation of AI-driven technologies are not adequate for systems that may adapt to new data and change from their original performance characteristics as evaluated. The European Diabetes Forum (EUDF) convened a working group to review and investigate the unmet needs around implementation of AI technology in diabetes care. The working group developed the framework and focus of the accompanying analysis through a series of virtual and face-to-face meetings, including email conversations. The working group examined the key objectives for good diabetes care in the context of current and predicted AI-driven clinical decision support systems (AI-CDSS), including the outcomes for people with diabetes, the goals for personalised medicine and the implications for guideline-driven diabetes services and healthcare professionals. The process covered the needs of primary care healthcare professionals, who will shoulder the majority of diabetes care. The challenge of developing regulatory concepts and processes that are sufficiently robust to be AI inclusive was considered as central to the outcomes. Based on the available evidence, the EUDF working group believes that AI-CDSS will deliver benefits for people with diabetes, although there are clear challenges to moving AI-CDSS into the practical clinical space. To encourage debate on how this can be achieved safely and effectively, at the conclusion of the process a series of 14 recommendations was agreed using a nominal group technique and Delphi methodology, which are discussed in context in this article.