Abstract
Stratifying individuals at risk for developing diabetes could enable targeted delivery of interventional programs to those at highest risk, while avoiding the effort and costs of prevention and treatment in those at low risk. The objective of this study was to explore the potential role of a Hidden Markov Model (HMM), a machine learning technique, in validating the performance of the Framingham Diabetes Risk Scoring Model (FDRSM), a well-respected prognostic model. Can HMM predict 8-year risk of developing diabetes in an individual effectively? To our knowledge, no study has attempted use of HMM to validate the performance of FDRSM. We used Electronic Medical Record (EMR) data, of 172,168 primary care patients to derive the 8-year risk of developing diabetes in an individual using HMM. The Area Under Receiver Operating Characteristic Curve (AROC) in our study sample of 911 individuals for whom all risk factors and follow up data were available is 86.9% compared to AROCs of 78.6% and 85% reported in a previously conducted validation study of FDRSM in the same Canadian population and the Framingham study respectively. These results demonstrate that the discrimination capability of our proposed HMM is superior to the validation study conducted using the FDRSM in a Canadian population and in the Framingham population. We conclude that HMM is capable of identifying patients at increased risk of developing diabetes within the next 8-years.