Development and internal validation of machine learning models for predicting prediabetes in China

Diabetes imposes a growing health burden among Chinese adults, necessitating scalable tools for early identification of high-risk individuals. We aimed to develop and internally validate survival machine-learning models for prediabetes risk stratification using routinely available clinical indicators.

This retrospective cohort study included 77,478 Chinese adults from the Dryad repository (2010-2016). Candidate predictors were selected via LASSO regression and random survival forests (RSF). Six survival models, Cox proportional hazards (Cox-PH), CoxBoost, DeepSurv, gradient boosting machine (GBM), random survival forests (RSF), and survival tree, were developed and evaluated using the concordance index (C-index), time-dependent ROC curves, calibration curves, and decision curve analysis (DCA). The best-performing model was deployed as a web-based application.

Eight predictors were consistently selected across methods: age, BMI, fasting plasma glucose, total cholesterol, triglycerides, HDL-C, LDL-C, and creatinine clearance rate. In the test set, DeepSurv and GBM achieved comparable discrimination (C-index: 0.756 vs. 0.751; adjusted P = 0.694). GBM was preferred due to better calibration and greater net benefit across clinically relevant thresholds, leading to its selection as the candidate model.

The GBM-based prediabetes risk model, built on eight inexpensive and routinely available clinical measures, showed promising internal discrimination and calibration in a large Chinese cohort. An interactive web tool was developed as a research prototype to facilitate future external validation and early risk identification. External validation in independent populations is warranted before clinical use.