Machine learning evaluation of clinical, social and behavioural factors influencing progression from pre-diabetes to type 2 diabetes: a retrospective cohort study in southeast Michigan

OBJECTIVE: We aimed to use machine learning (ML) models to investigate the impact of clinical, social and behavioural factors on 1-year progression from pre-diabetes to type 2 diabetes mellitus (DM). DESIGN: A retrospective cohort study. SETTING: A large health system including eight sites in southeast Michigan. PARTICIPANTS: Adults with haemoglobin A1c (HbA1c) between 5.7% and 6.4% for two consecutive years between 1 January 2008 and 31 December 2023, and no prior history of type 2 DM or metformin use. PRIMARY OUTCOME MEASURE: New-onset type 2 DM (HbA1c ≥6.5%) in 1 year. RESULTS: Among 11 809 individuals, 815 (6.9%) progressed to type 2 DM within 1 year. CatBoost demonstrated the best performance (average area under the curve 0.78). Prior-year HbA1c was the most influential covariate (SHapley Additive exPlanations 1.02). Traditional metabolic factors (high-density lipoprotein, body mass index (BMI), white blood cell, age, gender, triglycerides) also contributed. Lastly, while inclusion of social and behavioural determinants of health (SBDH) did not significantly improve the overall model performance, depression emerged as the prominent SBDH covariate. Depression was a stronger predictor of diabetes progression in individuals with higher baseline BMI and lower baseline HbA1c. CONCLUSIONS: Inclusion of social and behavioural covariates provided no incremental value for prediction of diabetes progression from pre-diabetes. However, machine learning revealed that depression may play a role in progression to type 2 DM.