Unveiling the Potential of Large Language Models in Transforming Chronic Disease Management: Mixed Methods Systematic Review.

backgroundChronic diseases are a major global health burden, accounting for nearly three-quarters of the deaths worldwide. Large language models (LLMs) are advanced artificial intelligence systems with transformative potential to optimize chronic disease management; however, robust evidence is lacking.

objectiveThis review aims to synthesize evidence on the feasibility, opportunities, and challenges of LLMs across the disease management spectrum, from prevention to screening, diagnosis, treatment, and long-term care.

methodsFollowing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, 11 databases (Cochrane Central Register of Controlled Trials, CINAHL, Embase, IEEE Xplore, MEDLINE via Ovid, ProQuest Health & Medicine Collection, ScienceDirect, Scopus, Web of Science Core Collection, China National Knowledge Internet, and SinoMed) were searched on April 17, 2024. Intervention and simulation studies that examined LLMs in the management of chronic diseases were included. The methodological quality of the included studies was evaluated using a rating rubric designed for simulation-based research and the risk of bias in nonrandomized studies of interventions tool for quasi-experimental studies. Narrative analysis with descriptive figures was used to synthesize the study findings. Random-effects meta-analyses were conducted to assess the pooled effect estimates of the feasibility of LLMs in chronic disease management.

resultsA total of 20 studies examined general-purpose (n=17) and retrieval-augmented generation-enhanced LLMs (n=3) for the management of chronic diseases, including cancer, cardiovascular diseases, and metabolic disorders. LLMs demonstrated feasibility across the chronic disease management spectrum by generating relevant, comprehensible, and accurate health recommendations (pooled accurate rate 71%, 95% CI 0.59-0.83; I

conclusionsLLMs have demonstrated the potential to transform chronic disease management at the individual, social, and health care levels; however, their direct application in clinical settings is still in its infancy. A multifaceted approach that incorporates robust data security, domain-specific model fine-tuning, multimodal data integration, and wearables is crucial for the evolution of LLMs into invaluable adjuncts for health care professionals to transform chronic disease management.

trial registrationPROSPERO CRD42024545412; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024545412.