{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T17:25:16Z","timestamp":1788456316206,"version":"build-2803163510"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"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. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with painful diabetic peripheral neuropathy (PDPN) increasingly use generative artificial intelligence chatbots for information on symptoms, treatment, foot care, and when to seek professional help. Their usefulness depends on safety, accuracy, guideline concordance, actionability, and readability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare five publicly accessible generative AI chatbots in answering standardized patient-oriented questions about PDPN. Methods: Sixty standardized English-language questions covering eight clinical domains were submitted once to ChatGPT, Gemini, Microsoft Copilot, DeepSeek, and Doubao in separate single-turn conversations, yielding 300 responses. Five reviewers independently assessed safety, accuracy, guideline concordance, and actionability using predefined criteria. Guideline concordance was scored against six mapped elements per question and converted to a percentage. Actionability was assessed using seven binary criteria with prespecified question-level applicability. Readability was evaluated using six established indices. Paired comparisons used Cochran\u2019s Q test for safety and Friedman tests for non-binary outcomes, followed by multiplicity-adjusted pairwise analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All 300 responses were analyzed. Inter-rater agreement was high for safety (Fleiss\u2019\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u202f=\u202f0.874), accuracy [ICC (2,1) = 0.881], guideline concordance [ICC (2,1) = 0.874], and actionability [ICC (2,1) = 0.877]. Twenty-eight responses (9.3%) were classified as unsafe or potentially unsafe. Unsafe-response rates ranged from 5.0 to 15.0%, with no detected overall between-model difference (Cochran\u2019s\n                      <jats:italic>Q<\/jats:italic>\n                      \u202f=\u202f4.462,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.347). Accuracy, guideline concordance, and actionability differed across models (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001; Kendall\u2019s\n                      <jats:italic>W<\/jats:italic>\n                      \u202f=\u202f0.683, 0.730, and 0.556, respectively). ChatGPT generally achieved higher content-related scores, whereas Doubao scored lower. All readability indices also differed across models (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), with ChatGPT and Doubao producing less complex text and DeepSeek showing greater reading difficulty.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The five chatbots showed distinct performance patterns across content quality and readability. Although no overall safety difference was detected, every system generated at least one response with a plausible pathway to inappropriate self-management, delayed assessment, medication or product misuse, or preventable injury. Chatbots may support general patient education, but medication decisions, foot-risk assessment, and urgent-care triage require professional verification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1942799","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:50:26Z","timestamp":1788454226000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A comparative evaluation of generative AI chatbots for patient-oriented advice on painful diabetic peripheral neuropathy: safety, accuracy, guideline concordance, actionability, and readability"],"prefix":"10.3389","volume":"14","author":[{"given":"Lina","family":"Gu","sequence":"first","affiliation":[{"name":"Department of Pain Medicine, The Affiliated Wuxi People\u2019s Hospital of Nanjing Medical University, Wuxi People\u2019s Hospital, Wuxi Medical Center, Nanjing Medical University","place":["Wuxi, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaole","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Mudanjiang Second People\u2019s Hospital","place":["Mudanjiang, Heilongjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, The Affiliated Wuxi People\u2019s Hospital of Nanjing Medical University, Wuxi People\u2019s Hospital, Wuxi Medical Center, Nanjing Medical University","place":["Wuxi, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Miao","sequence":"additional","affiliation":[{"name":"Nanquan Branch, Department of Gynecology, Xuelang Subdistrict Community Health Service Center","place":["Wuxi, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengfeng","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, The Affiliated Wuxi People\u2019s Hospital of Nanjing Medical University, Wuxi People\u2019s Hospital, Wuxi Medical Center, Nanjing Medical University","place":["Wuxi, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1038\/s41574-021-00496-z","article-title":"Pathogenesis, diagnosis and clinical management of diabetic sensorimotor peripheral neuropathy","volume":"17","author":"Sloan","year":"2021","journal-title":"Nat Rev Endocrinol"},{"key":"ref2","doi-asserted-by":"crossref","DOI":"10.2337\/db2022-01","volume-title":"Diagnosis and Treatment of Painful Diabetic Peripheral Neuropathy","author":"Pop-Busui","year":"2022"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1016\/S0140-6736(22)01472-6","article-title":"Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trial","volume":"400","author":"Tesfaye","year":"2022","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1212\/WNL.0000000000013038","article-title":"Oral and topical treatment of painful diabetic polyneuropathy: practice guideline update summary: report of the AAN guideline subcommittee","volume":"98","author":"Price","year":"2022","journal-title":"Neurology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"S231","DOI":"10.2337\/dc24-S012","article-title":"Retinopathy, neuropathy, and foot care: standards of Care in Diabetes\u20142024","volume":"47","year":"2024","journal-title":"Diabetes Care"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e3651","DOI":"10.1002\/dmrr.3651","article-title":"Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update)","volume":"40","author":"Bus","year":"2024","journal-title":"Diabetes Metab Res Rev"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"887","DOI":"10.3390\/healthcare11060887","article-title":"ChatGPT utility in healthcare education, research, and practice: systematic review on the promising perspectives and valid concerns","volume":"11","author":"Sallam","year":"2023","journal-title":"Healthcare"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1056\/NEJMsr2214184","article-title":"Benefits, limits, and risks of GPT-4 as an AI chatbot for medicine","volume":"388","author":"Lee","year":"2023","journal-title":"N Engl J Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1930","DOI":"10.1038\/s41591-023-02448-8","article-title":"Large language models in medicine","volume":"29","author":"Thirunavukarasu","year":"2023","journal-title":"Nat Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1038\/s41586-023-06291-2","article-title":"Large language models encode clinical knowledge","volume":"620","author":"Singhal","year":"2023","journal-title":"Nature"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1038\/s41586-023-05881-4","article-title":"Foundation models for generalist medical artificial intelligence","volume":"616","author":"Moor","year":"2023","journal-title":"Nature"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"104512","DOI":"10.1016\/j.ebiom.2023.104512","article-title":"Attention is not all you need: the complicated case of ethically using large language models in healthcare and medicine","volume":"90","author":"Harrer","year":"2023","journal-title":"EBioMedicine"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1001\/jama.2023.8288","article-title":"Accuracy of a generative artificial intelligence model in a complex diagnostic challenge","volume":"330","author":"Kanjee","year":"2023","journal-title":"JAMA"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e230424","DOI":"10.1148\/radiol.230424","article-title":"Appropriateness of breast cancer prevention and screening recommendations provided by ChatGPT","volume":"307","author":"Haver","year":"2023","journal-title":"Radiology"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.pec.2014.05.027","article-title":"Development of the patient education materials assessment tool (PEMAT): a new measure of understandability and actionability for print and audiovisual patient information","volume":"96","author":"Shoemaker","year":"2014","journal-title":"Patient Educ Couns"},{"key":"ref16","volume-title":"Automated Readability Index. AMRL-TR-66-220","author":"Smith","year":"1967"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1037\/h0076540","article-title":"A computer readability formula designed for machine scoring","volume":"60","author":"Coleman","year":"1975","journal-title":"J Appl Psychol"},{"key":"ref18","volume-title":"Derivation of New Readability Formulas for Navy Enlisted Personnel. Research Branch Report 8\u201375","author":"Kincaid","year":"1975"},{"key":"ref19","volume-title":"The Technique of Clear Writing","author":"Gunning","year":"1952"},{"key":"ref20","first-page":"639","article-title":"Smog grading\u2014a new readability formula","volume":"12","author":"McLaughlin","year":"1969","journal-title":"J Reading"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1037\/h0057532","article-title":"A new readability yardstick","volume":"32","author":"Flesch","year":"1948","journal-title":"J Appl Psychol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1037\/h0031619","article-title":"Measuring nominal scale agreement among many raters","volume":"76","author":"Fleiss","year":"1971","journal-title":"Psychol Bull"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A guideline of selecting and reporting intraclass correlation coefficients for reliability research","volume":"15","author":"Koo","year":"2016","journal-title":"J Chiropr Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1080\/01621459.1927.10502953","article-title":"Probable inference, the law of succession, and statistical inference","volume":"22","author":"Wilson","year":"1927","journal-title":"J Am Stat Assoc"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J R Stat Soc Series B Stat Methodol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1001\/jamainternmed.2023.1838","article-title":"Comparing physician and artificial intelligence chatbot responses to patient questions posted to a public social media forum","volume":"183","author":"Ayers","year":"2023","journal-title":"JAMA Intern Med"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1349","DOI":"10.1001\/jama.2023.5321","article-title":"AI-generated medical advice\u2014GPT and beyond","volume":"329","author":"Haupt","year":"2023","journal-title":"JAMA"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1166120","DOI":"10.3389\/fpubh.2023.1166120","article-title":"ChatGPT and the rise of large language models: the new AI-driven infodemic threat in public health","volume":"11","author":"De Angelis","year":"2023","journal-title":"Front Public Health"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1038\/s41746-023-00873-0","article-title":"The imperative for regulatory oversight of large language models, or generative AI, in healthcare","volume":"6","author":"Mesk\u00f3","year":"2023","journal-title":"NPJ Digit Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1038\/s43856-023-00370-1","article-title":"The future landscape of large language models in medicine","volume":"3","author":"Clusmann","year":"2023","journal-title":"Commun Med (Lond)"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e48568","DOI":"10.2196\/48568","article-title":"Utility of ChatGPT in clinical practice","volume":"25","author":"Liu","year":"2023","journal-title":"J Med Internet Res"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"pkad010","DOI":"10.1093\/jncics\/pkad010","article-title":"Artificial intelligence chatbots will revolutionize how cancer patients access information: ChatGPT represents a paradigm shift","volume":"7","author":"Hopkins","year":"2023","journal-title":"JNCI Cancer Spectr."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1459","DOI":"10.1001\/jamaoncol.2023.2954","article-title":"Use of artificial intelligence chatbots for cancer treatment information","volume":"9","author":"Chen","year":"2023","journal-title":"JAMA Oncol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"pkad015","DOI":"10.1093\/jncics\/pkad015","article-title":"Using ChatGPT to evaluate cancer myths and misconceptions: artificial intelligence and cancer information","volume":"7","author":"Johnson","year":"2023","journal-title":"JNCI Cancer Spectr"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e35179","DOI":"10.7759\/cureus.35179","article-title":"Artificial hallucinations in ChatGPT: implications in scientific writing","volume":"15","author":"Alkaissi","year":"2023","journal-title":"Cureus"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1942799\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:50:28Z","timestamp":1788454228000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1942799\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":35,"alternative-id":["10.3389\/fpubh.2026.1942799"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1942799","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"1942799"}}