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Context-Aware Optimization of Follow-Up Intervals for Type 2 Diabetes Care Using Markov Decision Processes

arXiv:2606.19092v1 Announce Type: cross Abstract: Chronic disease management relies on regular patient-provider interactions to follow-up on disease progression and control. For Type 2 Diabetes (T2D), current guidelines prescribe fixed time intervals between subsequent primary care visits for all patients, overlooking heterogeneity in clinical trajectories and patient characteristics. This study introduces a Contextual Markov Decision Process (CMDP) model to optimize subpopulation-specific follow-up interval decisions using Electronic Health Record (EHR) data from 22,154 T2D patients across 10 primary care clinics. Contexts are identified by: i) dimensionality reduction of variables representing the individual health trajectories utilizing Principal Component Analysis, and ii) assigning patients to contexts via principal components and additional patient-level features using clustering. Two distinct contexts emerged, representing a lower- and a higher-risk subpopulation. CMDP-derived policies recommend: (i) follow-up within 1 month if lab value at current visit is unmeasured; (ii) up to 3 months for elevated lab values or recent hospitalizations; and (iii) 6 to 12 months for sustained glycemic control, with shorter follow-up intervals for patients in high-risk context. The optimal policies achieved lower expected cumulative cost than benchmarks (e.g., in the higher-comorbidity context, the CMDP policy reduced cost by about 34.8%, and in the lower-comorbidity context by about 6.4%, relative to an American Diabetes Association-like fixed interval follow-up policy. These findings demonstrate how context-aware approaches can inform adaptive follow-up strategies, and have the potential to advance chronic care management in primary care by synthesizing machine learning and probabilistic decision models.

The ASE-LSE Disagreement Landscape: An End-to-End Characterisation of Extremes and Structural Drivers

arXiv:2605.22346v3 Announce Type: replace-cross Abstract: Two of the most widely used methods for analysing graph data, Adjacency Spectral Embedding and Laplacian Spectral Embedding, often produce different results when applied to the same graph. Yet the structural reasons behind this disagreement remain incompletely understood. This paper provides an end-to-end account of ASE-LSE latent subspace disagreement. We first prove that the two methods produce identical latent subspaces for every embedding dimension whenever the Laplacian is a scalar multiple of the adjacency matrix, and show that this scalar relationship holds if and only if the graph is either regular or bipartite biregular. This anchor result identifies a sufficient condition for perfect agreement that pins down the floor of the disagreement spectrum and supplies the baseline for the perturbation analysis. We then prove that no maximal-disagreement graph or family of graphs exists: the disagreement is always strictly below its theoretical ceiling, and we exhibit a witness family demonstrating that no finite maximum is attainable, so the disagreement landscape has no maximiser. With both endpoints established, we derive a Regularity Departure Bound whose two terms isolate degree heterogeneity and eigengap as the primary structural factors influencing disagreement in the middle regime. Empirical validation across thousands of simulated graphs confirms the mechanisms predicted by the bound: heterogeneity pushes disagreement up, eigengap suppresses it, and their joint ratio emerges as a unified predictor of ASE-LSE disagreement, suggesting when the two embeddings can be treated as interchangeable and when they cannot.

Order-Based Bayesian Network Modeling of Early Detection and Post-Diagnosis Control for Cardiovascular Disease Risk in Type 2 Diabetes

Patients diagnosed with type 2 diabetes (T2D) are at increased risk of developing cardiovascular disease (CVD), the leading cause of morbidity and mortality in this population. Early detection and glycemic control within the first year after diagnosis reduce CVD risk. However, gaps remain in how to operationalize early detection of T2D using Electronic Health Record (EHR) data and quantify its relationship with subsequent CVD risk using longitudinal observations. We developed a probabilistic graph model to analyze the interdependencies between early detection of T2D, post-diagnosis glycemic control, and CVD occurrence. Using a temporally structured Bayesian Network (BN) learned from EHR data of 9,450 primary care patients between 2017 and 2023, we quantified probabilistic dependencies between demographics, diagnostic delay surrogates, glycemic control, and post-diagnosis CVD occurrence. Percentile based thresholds defined risk groups, where individuals with predicted probabilities in the bottom decile ([≤] 10th percentile) were classified as low risk, and those in the top decile ([≥] 90th percentile) as high risk. Results demonstrated heterogeneity in predicted risks across glycemic and cardiovascular outcomes. Predicted probability of developing CVD within the first year after T2D diagnosis ranged from a mean of 5.2% in the low-risk group to 28.9% in the high-risk group, while predicted probabilities of mean Hemoglobin A1c (HbA1c) [≥] 8% during the first year post-diagnosis ranged from 1.6% in low-risk to 55.1% in high-risk group. Patients with HbA1c at diagnosis [≥] 8% had higher predicted probabilities of first-year post-diagnosis mean HbA1c [≥] 8% (53.3% vs. 1.9%) and high HbA1c coefficient of variation (18.7% vs. 3.1%) compared with those with HbA1c [≤] 6.5%. Incorporating early clinical outcomes refined later risk predictions, with long-term CVD risk reaching 33.5% among high-risk individuals. The proposed model achieved predictive performance comparable to conventional machine learning approaches while providing interpretable relationships for risk stratification in primary care populations.