Machine learning driven diabetes care using predictive-prescriptive analytics for personalized medication...

The increasing prevalence of type 2 diabetes (T2D) is a significant health concern worldwide. Effective and personalized treatment strategies are essential for improving patient outcomes and reducing healthcare costs. Machine learning (ML) has the potential to create clinical decision support systems (CDSS) that assist clinicians in making prediction-informed treatment decisions. This study aims to develop a novel predictive-prescriptive analytics framework that leverages ML to enhance medication prescriptions for T2D patients. The framework is designed as a data-driven CDSS to determine the best medication strategies based on individual patient profiles, including demographics, comorbidities, and medications. Utilizing a comprehensive dataset of electronic health records from 17,773 patients across various U.S. Veterans Administration Medical Centers collected over 12 years, the study employs the Bayesian Network (BN) as the ML model of choice. The BN's unique dual capability serves both predictive and prescriptive functions. Several BN learning algorithms are applied to map the relationships among patient features and decision variables for predicting the outcome. The prescriptive stage includes three strategies, i.e., forward, backward, and guideline-based, to identify optimal treatment recommendations. Next, the complex treatment pathways identified through the prescriptive stage were illustrated using rule-based and decision-tree presentations to improve interpretability for actionable insights and clinical usability. Finally, our empirical analysis examines the alignment between recommended treatment strategies and actual physician prescriptions. ML exhibited strong predictive performance with a precision of 0.789, a recall of 0.879, and an F1-score of 0.831. The recommended treatment strategies aligned with physician prescriptions in simpler treatment scenarios. However, the alignment decreased as the complexity of medication prescription increased, highlighting the challenges of achieving physician compliance with optimal strategies in complex scenarios. This underscores the greater need for CDSS, particularly in situations involving complex combination therapy. This study presents a novel ML-based CDSS framework for personalized T2D treatment. Leveraging ML, the framework offers a promising approach to optimizing medication prescriptions and improving patient outcomes.