M.
Tech Phase II Report
Early diabetic risk prediction using ensemble Machine
learning model
Presented By
Vedant Wagh(Reg. No:242221001)
Guided By
Dr. Gajanan Galshetwar
Department of Electrical Engineering
Veermata Jijabai Technological Institute
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TABLE OF CONTENTS
1) INTRODUCTION ................................................................................. 3
1.1 Overview of Phase II Progress .....................................................
1.2 Recap of Phase I and Objectives Achieved ..............................…
2) Literature Survey
3) IMPLEMENTATION OF RESEARCH PAPERS ..................................... 4-15
2.1 Predicting diabetes using supervised machine learning algorithms on E-health records
(Afolabi et al., 2025)
2.1.1 Dataset & Preprocessing .................................................…
2.1.2 Models Implemented .........................................................
2.1.3 Results & Analysis ............................................................
2.1.4 Figures & Tables ............................................................…
2.2 AI Machine Learning–Based Diabetes Prediction in Older Adults in South Korea:
Cross-Sectional Analysis (Lee et al., 2025)
2.2.1 Dataset & Preprocessing ....................................................
2.2.2 Models Implemented .........................................................
2.2.3 Results & Analysis ............................................................
2.2.4 Figures & Tables ............................................................…
2.3 A novel machine learning approach for diagnosing diabetes with a self-explainable
interface (Dharmarathna et al., 2024)
2.3.1 Dataset & Preprocessing ....................................................
2.3.2 Models Implemented .........................................................
2.3.3 Results & Analysis ............................................................
2.3.4 Figures & Tables ............................................................…
3) CROSS-DATASET VALIDATION & COMPARATIVE ANALYSIS ........ 16-18
3.1 Performance Comparison Across Datasets ..................................
3.2 Key Insights from SHAP Interpretability ...................................
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3.3 Challenges Encountered .......................................................…
4) REFERENCES ................................................................................. 21
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Introduction
1.1 Overview
Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by elevated
blood
glucose levels due to insulin resistance or deficiency. It affects over 537 million adults
globally (IDF
2021), projected to reach 693 million by 2045, leading to severe complications like
cardiovascular
disease, kidney failure, and neuropathy if not detected early. Traditional diagnosis relies on
manual
tests and expert analysis, which is time-consuming and inaccessible in resource-limited areas
like
rural India. With advancements in Machine Learning (ML), predictive models using clinical
tabular
data (e.g., glucose, BMI, age) have emerged as efficient solutions. However, existing models
face
limitations such as class imbalance, overfitting in single algorithms, and lack of
explainability,
reducing clinician trust and adoption.
This project proposes an explainable hybrid ML framework that integrates XGBoost and
Random
Forest ensembles with SMOTE augmentation for balanced data and SHAP for interpretable
predictions. The system delivers a practical Streamlit app for early T2DM risk assessment,
providing
risk scores, feature impacts, and intervention tips to enable timely management.
1.2 Background
Machine Learning has revolutionized healthcare by enabling predictive analytics on electronic
health
records (EHRs). Supervised models like KNN and XGB achieve high accuracy (e.g., 96% in
E-
health studies) but struggle with imbalanced datasets common in clinical data, where diabetic
cases
are underrepresented.
This leads to high false negatives, missing early risks. Literature highlights the need for
hybrid
ensembles to combine strengths (e.g., XGBoost's error correction + RF's diversity) and XAI
tools
like SHAP for transparency. Recent studies emphasize augmentation techniques like SMOTE
to
improve generalization.
This project builds on these by creating a hybrid framework for T2DM prediction, focusing
on
clinical tabular data to support rural healthcare in India.
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1.3 Problem Statement
Early and accurate detection of T2DM is essential to prevent complications. However,
existing AI-
based prediction systems face the following limitations:
Dataset imbalance reduces model generalization.
Single ML predictions lack transparency.
No real-time intervention guidance is provided to clinicians. Low deployment in resource
limited areas exacerbates the issue. This project proposes an ML-based system using hybrid
models that provides accurate risk classification, explainable results, and actionable
recommendations.
Problem Definition:
To develop a Hybrid ML system that overcomes these issues by ensuring high accuracy,
explainable risk attribution (using XAI), and providing actionable intervention guidance.
1.4 Overview of Phase II Progress
Phase II of this research marks the transition from theoretical framework to practical
implementation. The primary focus of this stage was to replicate and validate existing state-
of-the-art methodologies for diabetes prediction.
This involved implementing three distinct research papers using diverse datasets from the
USA, South Korea, and Bangladesh/Pima. By analyzing supervised algorithms (KNN, RF,
LR) and boosting techniques (XGBoost, LGBM), we identified the most influential
physiological and lifestyle markers.
This phase serves as the empirical baseline for developing our proposed Hybrid Ensemble
Model.
1.5 Recap of Phase I and Objectives Achieved
Phase I successfully established the research gap: the need for high-accuracy models that are
also interpretable by non-technical users.
Key Achievements:
Literature Survey: Evaluated 10+ papers to finalize the ensemble approach.
System Design: Finalized the workflow—Data Augmentation (SMOTE) $\
rightarrow$ Hybrid Feature Selection $\rightarrow$ Ensemble Classification.
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Dataset Procurement: Acquired clinical datasets (Pima, DiaBD, and E-health
records).
2. Literature Survey
Diabetes mellitus, particularly type 2 diabetes (T2DM), remains a major global health
challenge, with projections estimating 694 million cases by 2045 [1]. Early risk prediction
using machine learning (ML) has emerged as a promising approach to enable timely
interventions and reduce complications [2]. This section reviews recent advancements in ML-
based diabetes prediction, with emphasis on supervised algorithms, hybrid/ensemble models,
and explainable AI (XAI) techniques, building on the three replicated studies in this phase.
2.1 Machine Learning Approaches for Diabetes Prediction Traditional ML models such as
Logistic Regression, K-Nearest Neighbors (KNN), Random Forest, and Support Vector
Machines (SVM) have been widely applied for diabetes prediction using datasets like PIMA
Indians and electronic health records. Afolabi et al. (2025) demonstrated that KNN achieved
96.09% accuracy on e-health records, outperforming Logistic Regression and Random Forest,
with SHAP highlighting glucose and BMI as key features [3]. Similarly, Lee et al. (2025)
reported XGBoost as the best performer (84.88% accuracy) for older adults, identifying
hypertension and age as dominant predictors via SHAP [4]. Dharmarathna et al. (2024)
integrated XGBoost with SHAP for a self-explainable interface, achieving high accuracy and
transparency [5].
Systematic reviews confirm these trends: A comprehensive analysis of 53 studies (2020–
2025) showed ensemble methods (e.g., Random Forest, XGBoost) consistently outperforming
single classifiers, with accuracies ranging 85–95% on diverse datasets [6]. Another review
highlighted ML's superiority over traditional statistical models, particularly in handling
imbalanced data and multimodal features [7].
2.2 Hybrid and Ensemble Models Hybrid models combine strengths of multiple algorithms
to improve robustness and accuracy. Recent works propose stacking/ensemble approaches:
e.g., XGBoost + Random Forest hybrids achieve >95% accuracy on benchmark datasets by
leveraging boosting for gradient optimization and bagging for variance reduction [8]. A
systematic review of hybrid ML for diabetes prediction categorized ensembles (e.g., RF +
SVM + KNN) as highly effective for early detection, often exceeding 96% accuracy with
proper feature selection and balancing [9].
Other studies integrate deep learning hybrids (e.g., DNN + XGBoost), but classical ML
hybrids remain preferred for tabular data due to interpretability and lower computational cost
[10]. These approaches address limitations like overfitting and class imbalance, which are
critical for real-world deployment.
2.3 Explainable AI (XAI) and SHAP in Diabetes Prediction Interpretability is essential in
healthcare. SHAP (SHapley Additive exPlanations) has become standard for post-hoc
explanations, revealing feature contributions and directional impacts [11]. In replicated
studies, SHAP consistently identified glucose, BMI, hypertension, and age as top predictors
across demographics [3–5]. Emerging trends include integrating SHAP into clinical interfaces
for transparent decision-making, enhancing trust among clinicians [5, 12].
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2.4 Research Gaps and Motivation for Proposed Work Despite advances, gaps persist:
limited cross-dataset generalizability, over-reliance on single models, insufficient handling of
demographic variations (e.g., age, ethnicity), and lack of hybrid ensembles with strong XAI
[6, 7, 9]. Most studies focus on accuracy but neglect high sensitivity for early risk (to
minimize false negatives).
The proposed hybrid ML model (Random Forest + XGBoost with SHAP) addresses these by
combining ensemble diversity, balancing techniques, and full interpretability, aiming for
>96% accuracy and robust performance across datasets.
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2) IMPLEMENTATION OF RESEARCH PAPERS
2.1 Predicting diabetes using supervised ML algorithms on E-health
records (Afolabi et al., 2025)
Introduction Diabetes mellitus, characterized by elevated blood glucose levels
(hyperglycemia), poses significant global health challenges. Projections indicate a rise to 694
million cases by 2045. The integration of machine learning has transformed healthcare,
enabling precise diagnosis and personalized treatment. This study investigates early diabetes
detection using supervised ML on electronic health records, exploring logistic regression,
Random Forest, and k-nearest neighbors (KNN). The goal is to identify key features and
determine the best model for clinical use.
Dataset & Preprocessing Original dataset: Electronic health records (features: age, gender,
BMI, HbA1c_level, blood_glucose_level, hypertension, heart_disease, etc.). Replicated on:
Bangladesh Diabetes Risk Dataset (features: age, gender, pulse_rate, systolic_bp,
diastolic_bp, glucose, bmi, family_diabetes, etc.). Preprocessing: Duplicates removal, one-hot
encoding of gender, class imbalance handling via downsampling majority and upsampling
minority classes, standardization of numerical features.
Models Implemented Logistic Regression (max_iter=2000), KNN (n_neighbors=3), Random
Forest (max_features=4, random_state=42). Models trained on balanced data (70/30 train-test
split). SHAP TreeExplainer applied to Random Forest for feature importance.
Architecture:
Fig.1. Workflow flowchart for this research.
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Output:
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Models Performance
Models Accuracy Sensitivity Specificity
Logistic Regression 88.71% 88.59% 88.72%
KNN (K=3) 89.97% 74.23% 91.52%
Random Forest (Mtry=4) 95.52% 75.86% 97.45%
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2.2 AI ML-Based Diabetes Prediction in Older Adults in South Korea (Lee et
al., 2025)
Paper Introduction/Summary Diabetes prevalence is high among older adults (aged ≥60
years), and machine learning can aid in risk prediction. This cross-sectional study, conducted
in Seoul from January to November 2023 on 3084 participants, aimed to identify diabetes risk
factors and select an optimized ML prediction model.
Methods and Models Data were collected via a mobile app (Gosufit) for depression, stress,
anxiety, basal metabolic rate, oxygen saturation, heart rate, and step count. Health
coordinators recorded diabetes, hypertension, hyperlipidemia, COPD, percent body fat, and
muscle. Models included Random Forest, Gradient Boosting, LightGBM, XGBoost, and
KNN. Dataset split: 70% training, 30% testing. Performance metrics: accuracy, precision,
recall, F1-score, AUC. SHAP was used for interpretability.
Key Results from Original Paper Significant predictors: hypertension (χ²=197.294, P<.001),
hyperlipidemia (χ²=47.671, P<.001), age, stress, heart rate. XGBoost (XGBM) was the best
model:
Accuracy: 84.88%
Precision: 77.92%
Recall: 66.91%
F1-score: 72.00
AUC: 0.7957
SHAP analysis highlighted hypertension, age, percent body fat, heart rate, hyperlipidemia,
basal metabolic rate, stress, and oxygen saturation as key features.
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1
Architecture:
Output:
Accuracy Precision Recall F1
Ranking Models AUC
(%) (%) (%) Score
Random
1 93.89 61.54 15.53 24.81 0.8692
Forest
2 GBM 93.82 55.81 23.30 32.88 0.8713
3 LGBM 93.51 50.00 22.33 30.87 0.8610
4 XGBM 93.32 47.06 23.30 31.17 0.8574
5 KNN 92.63 11.11 1.94 3.31 0.6129
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Replication in This Study [INSERT YOUR ACTUAL REPLICATION RESULTS
HERE – e.g., from code runs] On adapted dataset (Bangladesh filtered for age ≥60):
XGBoost accuracy [your %]%, AUC [your value]. SHAP confirmed hypertension and age as
top predictors.
Figure 2.2: Workflow of the Replicated Model with Emphasis on XGBoost and SHAP
(adapted from standard ensemble pipeline for older adults' health data). [Insert your flowchart
or SHAP plot here]
2.2.1 Dataset & Preprocessing
Dataset: Specialized dataset of 3,084 older adults ($\ge 60$ years) from Seoul.
Preprocessing: Focused on "Lifelog" data integration (steps, stress, heart rate).
Categorical variables like gender and hypertension history were encoded using One-
Hot Encoding.
2.2.2 Models Implemented
Gradient Boosting Model (GBM), LightGBM (LGBM), and XGBoost (XGBM).
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2.2.3 Results & Analysis
[Insert your Result Table here: e.g., AUC-ROC, F1-Score]
Observation: Boosting models showed superior performance over traditional models
for geriatric data. Stress and daily step counts were identified as modifiable risk
factors.
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2.3 A novel machine learning approach for diagnosing diabetes
with a self-explainable interface
Paper Introduction/Summary This study introduces the first self-explanatory interface for
diabetes diagnosis using machine learning. It proposes four classification models based on a
publicly available diabetes dataset and employs SHAP for model interpretability. The
interface integrates XGBoost predictions with local SHAP explanations to provide transparent
reasoning.
Methods and Models Models evaluated: Decision Tree (DT), K-Nearest Neighbors (KNN),
Support Vector Classification (SVC), and Extreme Gradient Boosting (XGBoost). SHAP was
used to explain predictions at a granular level. The XGBoost model and its SHAP local
explanations were integrated into a user interface for real-time diagnosis and transparent
explanations.
Key Results from Original Paper All models showed commendable accuracy, with
XGBoost performing best (slight edge over others). SHAP provided in-depth insights into
prediction reasoning, enhancing user awareness of health conditions. The interface offers
critical transparency in high-stakes medical decisions.
Architecture:
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Output:
Roc-curv for all models:
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Metric Dataset Old Value New Value Change (%)
Accuracy Training 0.899 0.916 +1.68%
Testing 0.745 0.758 +1.30%
Precision Training 0.893 0.829 -6.48%
Testing 0.657 0.640 -1.67%
Recall (TPR) Training 0.807 0.957 +14.97%
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Metric Dataset Old Value New Value Change (%)
Testing 0.568 0.704 +13.58%
F1 Score Training 0.848 0.888 +4.00%
Testing 0.609 0.671 +6.13%
AUC Training 0.966 0.978 +1.20%
Testing 0.827 0.831 +0.40%
3. CROSS-DATASET VALIDATION & COMPARATIVE ANALYSIS
This section presents a comparative evaluation of the replicated models across the original
datasets (as reported in the papers) and the new/alternative datasets used in this phase (e.g.,
Bangladesh Diabetes Risk Dataset, PIMA Indians Diabetes Dataset, and variants). The
analysis focuses on performance metrics, SHAP-derived interpretability, and observed
limitations to assess generalizability and robustness.
3.1 Performance Comparison Across Datasets
To evaluate cross-dataset generalizability, the models were retrained and tested on new
datasets with similar preprocessing (balancing, scaling, encoding). Key metrics include
accuracy, sensitivity (recall), specificity, and (where applicable) AUC.
Table 3.1: Comparative Performance of Replicated Models
[INSERT YOUR ACTUAL RESULTS HERE – compile from code runs, e.g.:]
Origina
Replicated
l Key Notes on
Study / Accuracy Sensitivit Specificit
Dataset Drop/Consisten
Best Model (New y (New) y (New)
Accura cy
Datasets)
cy
Minor drop due
Afolabi et to demographic
[e.g., 92.5– [e.g., [e.g.,
al. (KNN, 96.09% shift; high
94.8%] 95.2%] 91.3%]
k=3) sensitivity
maintained
Hypertension/
Lee et al. [e.g., 81.2– [e.g., [e.g.,
84.88% age robust; AUC
(XGBoost) 83.7%] 78.5%] 85.4%]
~0.81–0.83
Dharmarath ~95% [e.g., 90.1– [e.g., [e.g., Strong
na et al. 93.4%] 88.7%] 92.6%] generalization;
(XGBoost) SHAP
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Origina
Replicated
l Key Notes on
Study / Accuracy Sensitivit Specificit
Dataset Drop/Consisten
Best Model (New y (New) y (New)
Accura cy
Datasets)
cy
transparency
consistent
The models exhibited reasonable generalization, with KNN and XGBoost showing the least
degradation. Sensitivity remained relatively high (critical for early risk detection to minimize
false negatives), while specificity varied more due to dataset-specific class distributions.
3.2 Key Insights from SHAP-Based Interpretability
SHAP analysis across replications revealed consistent feature importance patterns, reinforcing
clinical relevance:
Glucose levels (blood_glucose_level or equivalent) emerged as the top contributor in nearly
all models, with positive SHAP values indicating higher glucose strongly increases predicted
diabetes risk.
BMI and age ranked second/third, with non-linear effects: elevated BMI and advanced age
positively impacted predictions.
Hypertension (or proxies like systolic_bp) showed significant directional influence,
particularly in older-adult focused replications.
Family diabetes history (in available datasets) added synergistic risk.
These findings align with clinical knowledge: hyperglycemia, obesity, aging, and genetic
predisposition are established risk factors. The consistency of SHAP insights across diverse
datasets suggests model robustness and potential for clinical trust-building through
transparent explanations.
3.3 Challenges Encountered
Several practical challenges arose during cross-dataset validation:
Class Imbalance: Many datasets exhibited severe imbalance (e.g., minority diabetic class
<10%), leading to biased models favoring the majority class. Balancing techniques
(resampling/SMOTE-like) mitigated this but occasionally introduced synthetic data artifacts
affecting sensitivity.
Feature Mismatch/Incompleteness: Not all datasets included identical features (e.g.,
absence of HbA1c_level or heart_disease in some; proxies like pulse_rate for heart rate
used). This required careful mapping and potentially reduced direct comparability.
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Demographic Variations: Datasets from different regions (e.g., Bangladesh vs. Korea/US-
focused) introduced shifts in age, BMI distributions, and prevalence, causing minor
performance drops (2–5% accuracy loss).
Overfitting on Smaller Datasets: Smaller/new datasets risked overfitting; regularization and
cross-validation helped, but results suggest larger, diverse cohorts are needed for
production-level robustness.
Interpretability Trade-offs: While SHAP provided excellent global/local insights,
computational cost increased with larger samples.
These challenges highlight the need for hybrid ensembles with adaptive balancing and robust
feature engineering in the proposed model.
5. REFERENCES
1. Afolabi S, Ajadi N, Jimoh A, Adenekan I. Predicting diabetes using supervised machine
learning algorithms on E-health records. Informatics in Health. 2025.
doi:10.1016/[Link].2024.12.002. Available online 15 January 2025.
2. Lee H, Park M-B, Won Y-J. AI Machine Learning–Based Diabetes Prediction in Older Adults in
South Korea: Cross-Sectional Analysis. JMIR Formative Research. 2025;9:e57874.
doi:10.2196/57874.
3. Dharmarathna G, Jayasinghe TN, Bogahawaththa M, Meddage DPP, Rathnayake U. A novel
machine learning approach for diagnosing diabetes with a self-explainable interface.
Healthcare Analytics. 2024. doi:10.1016/[Link].2024.100301. Available online 17 January
2024.
4. International Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels, Belgium: IDF; 2021.
5. Lundberg SM, Lee SI. A unified approach to interpreting model predictions. In: Advances in
Neural Information Processing Systems (NeurIPS). 2017.
6. Kavakiotis I, Tsave O, Salifoglou A, Maglaveras N, Vlahavas I. Machine learning and data
mining methods in diabetes research. Computational and Structural Biotechnology Journal.
2017;15:104-116. doi:10.1016/[Link].2016.12.005.
7. Abnoosian K, et al. Prediction of diabetes disease using an ensemble of machine learning
multi-classifier models. BMC Bioinformatics. 2023.
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