An Optimal Decision Tree Model for Diabetes
Prediction and Diagnosis
Nayana S , Lakshmi Shrinivasan

Abstract—Diabetes is sometimes referred to as one of the most
deadly and persistent illnesses that can cause blood sugar levels.
Designing an efficient medical decision support system plays a
crucial and important role in predicting illness early and
helping specialists with the right medications. The reason for
this is the impairment of the insulin in the body, resulting in
abnormal carbohydrate metabolism and increased urine and
blood party numbers. This can lead to long-term damage and
dysfunction of various organs, especially the eyes, kidneys,
nerves and heart. Therefore, early detection and appropriate
medication can reduce the risk of these difficulties.
Classification techniques have continued to be used in medicine
for discovering patient data and achieving predictive models or
sets of rules. This study helped in the diagnosis of diabetes 0by
selecting0the optimal decision tree algorithm model. To control
the fitting of the decision0tree model, we use the Expectation-
maximization (EM) clustering algorithm to reduce the data and
split the data0into0three datasets. The decision tree0model is
built by selecting various hyperparameters so0that the most
accurate model0is chosen as the optimal model. To obtain the
prediction results, we used the Pima Indians Diabetes Dataset
(PIDD) from UCI Machine Learning Repository. These results
show that the proposed optimal decision tree model reached
higher precision compared with other previous studies
published in the literature. It can be proved that the model
proposed based on the results is useful for predicting and
diagnosing type 2 diabetes.
.
Keywords-diabetes diagnosis; data0mining; hyperparameters;
optimal0model; decision tree
I. INTRODUCTION
In recent0years, people's0irregular eating0habits have0led
to frequent0occurrence of0diseases. Diabetes, as0a0common
disease, is0one of0the fastest onset0diseases. This is because
the body's ability to produce or respond to insulin is
impaired, resulting in abnormal carbohydrate metabolism
and increased blood sugar and urine sugar levels [1].
Decision Support System (DSS) is an expert system used
in the medical0field to help doctors and0health professionals
make appropriate0knowledge-based decisions0in0different

Nayana S is with Department0of Electronics and0Communication, Ramaiah
Institute of0Technology, Bangalore, India. (email:
nayanashannika134@gmail.com)
Lakshmi0Shrinivasan is0with Department0of Electronics and
Communication, Ramaiah0Institute of Technology, Bangalore, India.
(email: lakshmi.s@msrit.edu
fields. [2]. An expert system is a computer program that
integrates knowledge to solve complex problems, and can
replace or support human experts. [3][4]. There is a link
between the interpretation of data for the diagnosed illness
and the diagnostic knowledge and information in the medical
field where appropriate treatment continues. Artificial
intelligence (AI) has received considerable interest for
diagnosis, especially from researchers in various disciplines
of medicine, because artificial intelligence-based DSS is
more efficient than other support systems [2].
The chronic high blood sugar in0diabetes is0associated
with organ0damage, disability, and0dysfunction of several
organs, particularly the0eyes, kidneys, nerves, heart, and
blood vessels. The majority of diabetes can be0divided into
two categories. type 1 and type 2. The cause0of type 1
diabetes is an absolute0lack of insulin secretion. On
the0other hand, type 2 diabetes is much0more prevalent,
and0the cause0is a combination of0resistance to insulin
action and a poorly compensated insulin-secreting response
[5].
II.BACKGROUND
Diabetes mellitus is a chronic disease caused by a
decrease in insulin production by the body's pancreas and is
called diabetes type I. Or, diabetes type II becomes
unresponsive to the insulin produced, causing blood sugar
levels to rise above normal [6].
In the0long run, both of these0conditions cause heart
failure, which causes serious damage to various organs0in the
body that are not controlled by the appropriate medications.
According to a survey conducted by the World Health
Organization, the number of people living with this chronic
disease currently costs around 3.7 billion rupees worldwide,
and is expected to double that number0by 2030.
Therefore, there0is0a need0for an0expert system
for0early diagnosis0and prediction of0diabetes that can
handle the ambiguous and uncertain data commonly
occurring in the medical field. The fuzzy-based model is
one0of the cost-effective systems that is0beneficial to these
medical systems. Powerful reasoning capabilities,
eliminating these uncertainties and providing an accurate
solution [7]. Adaptive Neuro-fuzzy Inference-
System0(ANFIS) integrates the principles of fuzzy logic and
neural networks into a single frame, with the functions of
both0interpolation and-learning. As a result, nonlinear
functions are efficiently estimated using these0combined
functions. The neural0network of ANFIS is integrated with
the Takagi-Sugeno0fuzzy reasoning0system according to
mathematical calculations that can solve complex problems
[8].
Type 2 diabetes has a very high-incidence worldwide.
Prevention and-treatment of type 2 diabetes requires early
detection. Today, data mining technology has become
increasingly important in the field of medical diagnostics for
its classification and predictive capabilities. In0this paper, we
provide a0hybrid predictive model that is useful in
diagnosing type 2 diabetes. In the0proposed prediction
model, the K-means algorithm is used for0data reduction,
using the J48 decision0tree as a classifier-for classifying the
data. [9].
The key purpose of the paper is to explore and provide a
better diagnosis and prediction of diabetes by predicting the
blood glucose level in an advance that is before 2 hours.
Presently there are a quite a lot of other methodologies do
employ on classification for the diabetes disease (DD). The
planned methodology that has been adopted for the
classification and prediction, on the selected feature is J48
Decision Tree algorithm [10].
Data mining is a common method for investigating
unknown patterns and rules of prediction and classification.
One of the data mining methods is the decision0tree
algorithm. It is0a classification0method that0uses a0decision
tree0as its representation, and0includes three0kinds
of0nodes: root node, internal0node, target0node, or end node
[11].
Advances in science0and technology can help
professionals diagnose0diabetes by analyzing0diabetes data
and diagnosing diabetes0in an0appropriate way. Many
methodologies are applied in the0field of0diabetes,
among0which data0mining is one0of the
most0important0methods. This is0the fastest method used in
decision tree data mining. This0paper proposes0a
decision0tree-based algorithm for0diabetes prediction and
diagnosis.
III. PROPOSED METHODOLOGY
The proposed task presents a simple but effective optimal
decision tree-based classification and prediction of0type 2
diabetes. Decision0Tree PIMA Developed using India's
Diabetes Database (PIDD).
Figure. 1. General block diagram of Artificial intelligence as an expert
system in medical diagnosis
A well-designed clinical decision support system (CDSS)
enhances medical decisions using clinical knowledge and
patient health information. The general block diagram of
Artificial intelligence based expert system for diagnosis in
medical field is shown in Figure 1. It is a tool that provides
medical professionals, patients and caretakers all the
necessary information belongs to a person. This improvises
attention and medication quality avoiding errors or
uncertainable events thus making the entire process more
efficient and accurate. CDSS tools are increasingly adapting
artificial intelligence (AI) expert systems to manage complex
and big data analytics. AI algorithms like Optimal decision
tree, fuzzy logic, neural network, machine learning etc., have
the ability to consume large amount of data, process them by
identifying patterns and provide users with desired results
Observations in PIDD show that "0" indicates a negative
diagnosis and "1" indicates a positive0diagnosis. This
decision tree algorithm was used0to
determine0the0probability of developing diabetes in a-
patient0based on clinical examination and observed
symptoms. Diabetes0can affectnboth women and men of
different ages. Parameters such as insulin level, blood
glucose, obesity index (BMI), diabetic lineage function
(DPF), and age0were given as0inputs in each0patient and the
probability of0occurrence of0diabetes was calculated.
A. Decision tree
It is expected that Data Mining is one0of the most
revolutionary0developments in the coming0decades. Data
mining is a common medium to explore unknown models
or foreseeable rules. One of the methods of data0mining is
a decision tree. Tree decisions are a classification method
that allows installations to run with three buttons: original
keys, internal buttons, ends or destination nodes. Each key
represents0an0attribute. Its0branch is the value0of
attributes and leaves representing the class. Of course, the
family0of crucial tree0algorithms can process
classification and number0features. The first0step in the
proposed0system is to identify input and output0attributes.
The0output is set between 0 to the unity. The likelihood of
diabetes is based on the given input parameters. MATLAB
Toolbox was used to design decision trees.
B. EM Clustering
Expectation-maximizing clustering uses a specific
multivariate0Gaussian probability0distribution function
model to estimate0the probability that0a particular
data0point belongs0to a0cluster. That0is, each0cluster
is0considered a Gaussian0function0model. This is0mainly
done by0alternating the two0steps.
a) Expected Value (E-Step): For every specified data-point,
the0probability of belonging to each0cluster is0calculated as
the0weight of the data point. If a0point belongs to a cluster,
its probability0is more likely to be assigned a value close to
1. If a point is likely to belong to more than one cluster, then
the following probability distribution should be established.
Clustering of data points.
b) Maximization M-Step: This step mainly uses the weights
of the data points computed in0the previous0step to0estimate
the relevant parameters0of each0cluster. Each data0point
computed the variance and mean of each cluster weighted
with probability0in E-Step. The0overall0probability
or0maximum probability of the next clustering0is retrieved.
These two stages are continuously rotated, increasing
the0total possibility of the number of units until convergence
occurs. Several iterative steps are0required to0prevent
local0optimization. Classification machine the0maximum
number0of times0a series0of decisions0can be made to
classify a given sample. Decreasing the0levels in0the
decision0tree helps avoid overfitting0the training data to
predictions.
C. Dataset
I used0the PIMA0Dataset, which0is universally
obtained from0the UCI0repository, to carry out my
research. This dataset consists of multiple independent
medical prediction variables and the dependent variable
(result) of one target variable. Independent variables
include attributes such as pregnancy, body mass index,
blood sugar, blood pressure, insulin, skin thickness, and
age. And the results explain if the patient has diabetes
(result 0 is "no diabetes", 1 is "yes").
IV. CLASSIFICATION PROCESS.
The steps for the classification and prediction of diabetes
using decision tree are showed in Figure 2:
Figure. 2 Proposed diabetes Classification model.
1. Data Preprocessing
The misclassified data were partitioned into different
datasets for evaluation and training of the deleted model
using the EM clustering algorithm. We construct training set
1 by oddly choosing 70% among the entire data-set. The
remaining 30% of the dataset is applied as0a0test dataset
to0estimate0the performance0of the0decision-tree algorithm.
Since0the0model has0been tested multiple times, it is0easy
to0overfit the0model by0evaluating it on the same dataset.
To0evaluate the0model more efficiently, training0set 1 is
split into0two subsets0of 90 sets 100sets. The090 sets
above0are used0to train each0model called0training set 2.
The0remaining 10% of0the data is0used as a cross-test set
(CV0set) to evaluate0the model. As0shown in0Figure 3, the
entire data0set is0split0into three0subsets: training0set 2,
CV0set, and0test0set.
Figure. 3 Partitioned datasets
2. Training Model
Finding the right hyperparameter type for a decision tree
algorithm requires building a model that tests combinations
of
hyperparameters. 70% of0the data0set is utilized for training
the decision-tree model.
3. Prediction
After training the model with the dataset we0will
choose0the optimal0decision-tree0model. Depend on the
probability of occurrence values the prediction of diabetes is
Calculated.
4. Model-Evaluation and Performance-Evaluation
In this segment, several measures are computed to evaluate
how0good or0accurate the classifier is to predict the class
labels (dataset) of the tuples. Precision, Sensitivity, and
Specificity: First, there are four additional terms you should
be aware of that are used in the calculations of many rating
scales.
a) Real mood or True positive (TP): Positive record or
record are properly marked by the classification.
b) Real negative (TN): The negative0records are correctly
marked by the classification.
C) False Support (FP): The negative0records are0incorrectly
marked.
d) False negative (FN): Positive0records are0misleading, is
negative. This study uses the following equations for
measuring accuracy, sensitivity0and specificity.
V. Confusion matrix
The confusion0matrix is a0useful tool for0analyzing how
well the categorizer predictive self recognizes different sets
of classes. TP0and TN will notify you when0the classifier
problem is being resolved FP and FN will be notified when
there is a categorizer. For a precision sorter, ideally most
pairs are represented0along the0diagonal of0the
confusion0matrix, with the rest of the items being 0 or close
to 0. The confusion matrix represented using the real and
predictive classes is shown in Figure 4.
 Figure 4. Confusion matrix

VI. RESULTS AND DISCUSSION

In this study, we first used EM clustering to remove

inaccurately classified samples. Then divide the entire
sample into a training-set0and a0test-set. The training set is
utilized to train0the decision-tree0model. From0the Figure 6. The Decision Tree Classification Visualization.
confusion matrix we obtained that 83 samples were True
positive, 59 were TN, 6 were FN and 5 were FP. A graph of
glucose levels for the probability of developing diabetes is
shown in Figure 5.

Figure 7. Regression Tree

The decisin Tree Classifier Visualization is shown in

Figure 6 andRegression Tree is shown in Figure 7.
Figure 5. The probability of occurrence of Diabetes VS Glucose Values.
.
TABLE 1
Performance0validation of0different classification0models

Classification0Model Accuracy Percentage

J48 Algorithm 73.82%
C4.5 Algorithm 74.5%
K-means and Decision Tree 78.16%
ANFIS 86.46%
This Study (Optimal decision 92.6%
tree)
 VII. CONCLUSION
The results obtained as shown in Table 1 show that the
Optimal Decision tree classification model is more accurate
than other classification models. Comparing with the above
results, it can be seen that the proposed model has been able
to obtain very accurate results in classifying type 2 diabetic
patients. The proposed model applies only to numerical data
and can be improved so that you can see the behavior of
different0types of0medical data, such0as images0and signals.
Further research is needed to0evaluate the0effectiveness
of0the proposed method with a larger amount of0data for
practical implementation.

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