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ORIGINAL RESEARCH article

Front. Endocrinol.

Sec. Clinical Diabetes

Volume 16 - 2025 | doi: 10.3389/fendo.2025.1689312

This article is part of the Research TopicDigital Technology in the Management and Prevention of Diabetes: Volume IIIView all 7 articles

Explainable artificial intelligence model predicting the risk of all-cause mortality in patients with type 2 diabetes mellitus

Provisionally accepted
Olga  VershininaOlga Vershinina1*Jacopo  SabbatinelliJacopo Sabbatinelli2,3*Anna Rita  BonfigliAnna Rita Bonfigli3Dalila  ColombarettiDalila Colombaretti4Angelica  GiulianiAngelica Giuliani4Mikhail  KrivonosovMikhail Krivonosov1Arseniy  TrukhanovArseniy Trukhanov5Claudio  FranceschiClaudio Franceschi1Mikhail  IvanchenkoMikhail Ivanchenko1Fabiola  OlivieriFabiola Olivieri3,4
  • 1Nacional'nyj issledovatel'skij Nizegorodskij gosudarstvennyj universitet imeni N I Lobacevskogo, Nizhny Novgorod, Russia
  • 2Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
  • 3INRCA-IRCCS, Ancona, Italy
  • 4Universita Politecnica delle Marche Dipartimento di Scienze Cliniche e Molecolari, Ancona, Italy
  • 5Mriya Life Institute, National Academy of Active Longevity, Moscow, Russia

The final, formatted version of the article will be published soon.

Background: Type 2 diabetes mellitus (T2DM) is a highly prevalent non-communicable chronic disease that substantially reduces life expectancy. Accurate estimation of all-cause mortality risk in T2DM patients is crucial for personalizing and optimizing treatment strategies. Methods: This study analyzed a cohort of 554 patients (aged 40-87 years) with diagnosed T2DM over a maximum follow-up period of 16.8 years, during which 202 patients (36%) died. Key survival-associated features were identified, and multiple machine learning (ML) models were trained and validated to predict all-cause mortality risk. To improve model interpretability, Shapley additive explanations (SHAP) was applied to the best-performing model. Results: The extra survival trees (EST) model, incorporating ten key features, demonstrated the best predictive performance. The model achieved a C-statistic of 0.776, with the area under the receiver operating characteristic curve (AUC) values of 0.86, 0.80, 0.841, and 0.826 for 5-, 10-, 15-, and 16.8-year all-cause mortality predictions, respectively. The SHAP approach was employed to interpret the model's individual decision-making processes. Conclusion: The developed model exhibited strong predictive performance for mortality risk This is a provisional file, not the final typeset article assessment. Its clinically interpretable outputs enable potential bedside application, improving the identification of high-risk patients and supporting timely treatment optimization.

Keywords: type 2 diabetes, All-cause mortality risk, predictive model, machine learning, Explainable artificial intelligence

Received: 20 Aug 2025; Accepted: 06 Oct 2025.

Copyright: © 2025 Vershinina, Sabbatinelli, Bonfigli, Colombaretti, Giuliani, Krivonosov, Trukhanov, Franceschi, Ivanchenko and Olivieri. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Olga Vershinina, olya.vershinina@itmm.unn.ru
Jacopo Sabbatinelli, j.sabbatinelli@univpm.it

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