An Interpretable Fuzzy Distance-Based Ensemble Framework with SHAP Analysis for Clinically Transparent Prediction of...

Background/Objectives: Diabetes is a chronic metabolic disorder affecting global health, where early prediction can significantly reduce disease severity. Methods: This research proposes an interpretable multi-metric fuzzy distance-based ensemble (MMFDE) that integrates multi-variant gradient-boosting classifiers (GBM, LightGBM, XGBoost, and AdaBoost) through a novel fuzzy fusion mechanism designed for intrinsic interpretability. Unlike conventional ensembles relying on opaque averaging or voting, MMFDE transforms base classifier predictions into a high-dimensional fuzzy space quantified via a weighted hybrid distance incorporating Euclidean, Manhattan, Chebyshev, and cosine metrics against ideal diabetic and non-diabetic reference vectors. These distances are translated into membership degrees with the help of exponentially decaying functions, which give clinicians calibrated confidence scores for every prediction. Comprehensive SHAP analysis identifies important clinical risk factors (glucose, BMI, and diabetes pedigree function), which show concordance with the medical literature, thereby giving greater clinical trust. Results: Experimental evaluations on two publicly available datasets, Hospital Frankfurt Germany Diabetes Dataset (HFGDD) and Pima Indians Diabetes Dataset (PIDD), show that MMFDE outperforms all base models with a significant accuracy of 94.83% and Area Under the Curve (AUC) of 97.66% on HFGDD and three different levels of interpretability: geometric transparency via distance-based decisions, confidence-calibrated uncertainty estimates, and feature-level explanations via SHAP. The confidence thresholds enabled in the framework support risk stratification clinical workflows with high-confidence predictions for automated screening and cases with moderate/low confidence flagged out for review by the clinician. Conclusions: By demonstrating that high performance and interpretability need not be mutually exclusive, MMFDE advances trustworthy AI for clinical decision support, addressing the critical need for transparent and clinically actionable diabetes prediction systems.