{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:04:47Z","timestamp":1789538687507,"version":"build-2803163510"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetes management increasingly requires coordination across Western medicine, traditional Chinese medicine (TCM), and lifestyle-based health management. General-purpose large language models (LLMs) can generate clinical text but may lack reliable source grounding and structured cross-disciplinary reasoning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We developed CDTD-Agent, a retrieval-augmented multi-agent framework that combines a domain-specific knowledge base with an Extract-Retrieve-Reason workflow. The knowledge base included 12 medical textbooks, 8 clinical guidelines, and 183 expert-reviewed diabetes cases. In a blinded single-case pilot evaluation, 30 senior experts rated anonymized recommendations from CDTD-Agent, GPT-4o, DeepSeek-V3.2-Exp, Doubao, and two attending physicians across eight dimensions. Linear mixed-effects models accounted for repeated ratings within evaluators, with Holm correction across eight omnibus tests and global Benjamini-Hochberg correction across 40 focused CDTD-Agent-versus-comparator contrasts. A\n                      <jats:italic>post hoc<\/jats:italic>\n                      backbone-only ablation compared the full framework with Qwen3\u2013235B-A22B using the same case and external prompt without retrieval or role-structured multi-agent processing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Significant source effects were detected in all eight dimensions after Holm correction (all adjusted\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). After global false discovery rate correction, CDTD-Agent received significantly higher ratings than all three general-purpose LLMs in five dimensions: safety, examination appropriateness, Western medicine treatment appropriateness, TCM treatment appropriateness, and evidence adherence. The largest differences occurred in Western medicine treatment appropriateness, where CDTD-Agent scored 4.07\u2009\u00b1\u20090.94 versus 1.37\u20131.60 for the general-purpose LLMs (all adjusted\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Non-parametric sensitivity analyses agreed with the mixed-effects results for 39 of 40 focused contrasts. In the\n                      <jats:italic>post hoc<\/jats:italic>\n                      ablation, the full framework outperformed the backbone-only condition in seven of eight dimensions after Holm correction; health management was not significantly different (adjusted\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.080).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this standardized complex T2DM case, CDTD-Agent received favorable expert ratings relative to the evaluated general-purpose LLMs in several clinically important dimensions. These findings are scenario-specific and do not establish generalizable clinical performance or isolate the effects of individual framework components. Multicase, repeated-generation, factorial-ablation, external, and prospective validation is needed before clinical deployment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fdgth.2026.1923975","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:31:48Z","timestamp":1789536708000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["CDTD-Agent: a retrieval-augmented multi-agent digital health framework for integrated diabetes care: a single-case expert-rated pilot study"],"prefix":"10.3389","volume":"8","author":[{"given":"Jieyi","family":"Zhang","sequence":"first","affiliation":[{"name":"Center of Integrated Chinese and Western Medicine, The First Affiliated Hospital of Xiamen University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luqing","family":"Wu","sequence":"additional","affiliation":[{"name":"Xiamen ITG Health Technology Co., Ltd.","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jielong","family":"Wu","sequence":"additional","affiliation":[{"name":"Center of Integrated Chinese and Western Medicine, The First Affiliated Hospital of Xiamen University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoming","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Artificial Intelligence, School of Electrical Engineering and Automation, Xiamen University of Technology","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijin","family":"Lin","sequence":"additional","affiliation":[{"name":"Center of Integrated Chinese and Western Medicine, The First Affiliated Hospital of Xiamen University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nengjiang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Center of Integrated Chinese and Western Medicine, The First Affiliated Hospital of Xiamen University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihai","family":"Zhang","sequence":"additional","affiliation":[{"name":"Center of Integrated Chinese and Western Medicine, The First Affiliated Hospital of Xiamen University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miaona","family":"Cai","sequence":"additional","affiliation":[{"name":"Center of Integrated Chinese and Western Medicine, The First Affiliated Hospital of Xiamen University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meiqi","family":"Chen","sequence":"additional","affiliation":[{"name":"Center of Integrated Chinese and Western Medicine, The First Affiliated Hospital of Xiamen University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuyu","family":"Yang","sequence":"additional","affiliation":[{"name":"Center of Integrated Chinese and Western Medicine, The First Affiliated Hospital of Xiamen University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Li","sequence":"additional","affiliation":[{"name":"Center of Integrated Chinese and Western Medicine, The First Affiliated Hospital of Xiamen University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/S2213-8587(25)00299-2","article-title":"11th edition of the IDF Diabetes Atlas: global, regional, and national diabetes prevalence estimates for 2024 and projections for 2050","volume":"14","author":"Genitsaridi","year":"2026","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/S0140-6736(23)01301-6","article-title":". 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