Insulin resistance prediction from wearables and routine blood biomarkers

Insulin resistance (IR), a primary precursor to type 2 diabetes, is characterized by impaired insulin action in tissues1. However, diagnostic methods remain expensive and inaccessible, which hinders early intervention2,3. Here we present the WEAR-ME study, a large, remotely conducted study of IR (n = 1,165 participants; median body mass index (BMI) = 28 kg m−2, median age = 45 years, median haemoglobin A1c (HbA1c) = 5.4%) that uses time-series data from wearable devices and routine blood biomarkers to train deep neural networks against a ground-truth measure of IR (homeostatic model assessment of IR; HOMA-IR). Using a HOMA-IR cut-off of 2.9, our multimodal model achieved robust performance (area under the receiver operating characteristic curve (AUROC) = 0.80, sensitivity = 76%, specificity = 84%) with data from wearable devices, together with demographic and routine blood biomarker data. To enhance the use of time-series data from wearables, we fine-tuned a wearable foundation model (WFM) pretrained on 40 million hours of sensor data. In an independent validation cohort (n = 72), a model integrating WFM-derived representations with demographic data surpassed a demographics-only baseline (AUROC = 0.75 versus 0.66). Moreover, adding WFM-derived representations to a model with demographics, fasting glucose and a lipid panel substantially improved performance, compared with an identical model without data from wearables (AUROC = 0.88 versus 0.76). We integrate IR prediction into a large language model to contextualize the results and facilitate personalized recommendations. This work establishes a scalable, accessible framework for the early detection of metabolic risk, which could enable timely lifestyle interventions to prevent progression to type 2 diabetes. A machine-learning model that integrates data from wearable devices (such as smartwatches) with blood biomarkers and demographic data can predict whether someone has insulin resistance, enabling timely lifestyle interventions to prevent progression to type 2 diabetes.