Shabestari Motahare, Mehrabbeik Akram, Barbieri Sebastiano, Marques-Vidal Pedro, Heshmati-Nasab Poria, Azizi Reyhaneh
Yazd Cardiovascular Research Center, Non-Communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Shahid Sadoughi University of Medical Sciences and Health Services, Yazd Diabetic Research Centre, Yazd, Iran.
Sci Rep. 2025 May 25;15(1):18143. doi: 10.1038/s41598-025-03030-7.
Hypoglycemia is a serious complication in individuals with type 2 diabetes mellitus. Identifying who is most at risk remains challenging due to the non-linear relationships between hypoglycemia and its associated risk factors. The objective of this study is to evaluate the importance and impact of risk factors related to the incidence of hypoglycemia through an explainable machine learning method. This prospective study enrolled 1306 adults with type 2 diabetes mellitus at a specialized diabetes center. Over three months, participants were asked to do self-monitoring blood glucose measurements and record hypoglycemic events. Nine clinically relevant features were analyzed using five machine learning models. The performance of the models was evaluated by different metrics. The SHapley Additive exPlanation method was used to elucidate how each covariate influenced the risk of hypoglycemia. Overall, 419 participants (32.08%) reported at least one hypoglycemic episode. Our findings highlight the non-linear nature of hypoglycemia risk in individuals with T2DM. Insulin therapy, Diabetes duration (> 13.7 years), and eGFR (< 60.2 mL/min/1.73 m) were the most important predictors of hypoglycemia, followed by age, HbA1C, triglycerides, total cholesterol, gender, and BMI.
低血糖是2型糖尿病患者的一种严重并发症。由于低血糖与其相关危险因素之间存在非线性关系，确定谁的风险最高仍然具有挑战性。本研究的目的是通过一种可解释的机器学习方法，评估与低血糖发生率相关的危险因素的重要性和影响。这项前瞻性研究在一家专业糖尿病中心招募了1306名2型糖尿病成年人。在三个月的时间里，参与者被要求进行自我血糖监测并记录低血糖事件。使用五种机器学习模型分析了九个临床相关特征。通过不同指标评估模型的性能。使用SHapley加性解释方法来阐明每个协变量如何影响低血糖风险。总体而言，419名参与者（32.08%）报告至少有一次低血糖发作。我们的研究结果突出了2型糖尿病患者低血糖风险的非线性性质。胰岛素治疗、糖尿病病程（>13.7年）和估算肾小球滤过率（<60.2 mL/min/1.73 m²）是低血糖最重要的预测因素，其次是年龄、糖化血红蛋白、甘油三酯、总胆固醇、性别和体重指数。
