IoMT–Fog–Cloud-based AI frameworks for chronic disease diagnosis: updated comparative analysis with recent AI-IoMT models (2020–2025)

Abstract

Chronic diseases such as diabetes and cardiovascular disease require frequent monitoring and timely clinical feedback to prevent complications. Internet of Medical Things (IoMT) systems increasingly combine near-patient sensing with Fog and Cloud computing so that time-critical preprocessing and inference can run close to the patient while compute-intensive training and population-level analytics remain in the Cloud. This review synthesizes primary studies published between 2020 and 2025 that implement AI-enabled IoMT, with an emphasis on systems that report both diagnostic performance and network quality-of-service (QoS). Following PRISMA 2020, we screened database records and included 14 primary studies; we focus the joint performance-QoS synthesis on six IoMT-Fog-Cloud frameworks for diabetes and cardiovascular disease and compare them with two recent multi-disease AI-IoMT models (DACL and TasLA). Diabetes-oriented implementations commonly report accuracy around 95%-96% using explainable or ensemble deep learning, whereas some cardiovascular frameworks report >99% accuracy in controlled settings; we therefore discuss plausible sources of optimistic performance, including small datasets, class imbalance, curated benchmarks, and potential leakage/overfitting in simulation-based evaluations. Across IoMT-Fog-Cloud studies, placing preprocessing and/or inference at the Fog layer repeatedly reduces end-to-end latency for streaming biosignals, but multi-Fog provisioning can increase energy and power demands. To support more reproducible comparisons, we organize 14 extracted metrics into (i) diagnostic performance (accuracy, precision, recall, F1-score, sensitivity, specificity) and (ii) system/network QoS (latency, jitter, throughput, bandwidth utilization, processing/execution time, network usage, energy consumption, power consumption), and we translate the evidence into study-linked design recommendations for future deployments.