2020 2nd International Conference on Sustainable Technologies for

Industry 4.0 (STI), 19-20 December, Dhaka

Prognostic Biomarkers Identification for Diabetes

Prediction by Utilizing Machine Learning Classifiers
Utsha Das∗ , Azmain Yakin Srizon† , Md. Ansarul Islam‡ , Dhiman Sikder Tonmoy§ , Md. Al Mehedi Hasan¶
∗†‡¶ Departmentof Computer Science and Engineering
§ Department
of Electrical and Computer Engineering
∗‡ Green University of Bangladesh, Dhaka, Bangladesh
†§¶ Rajshahi University of Engineering and Technology, Rajshahi, Bangladesh

Email: ∗ utshadas5@gmail.com, † azmainsrizon@gmail.com, ‡ ansarul.islam117@gmail.com,

§ tonmoysikder001@gmail.com, ¶ mehedi ru@yahoo.com

Abstract—Diabetes caused 4.2 million deaths in 2019 alone
which makes it the seventh leading cause of death worldwide.
Although diabetes can be treated, late treatment can be fatal
and may result in early death. Moreover, diabetes is a costly
disease to maintain, hence, early detection of diabetes can
facilitate the patients by indicating the time to seek treatment
and to get prepared mentally and financially. Previously,
various studies suggested and proposed different approaches
for achieving near-perfect accuracy but not many works
focused on finding the appropriate attributes which can predict
the disease at the early stage. In this study, we focused on
finding those significant features and our experimental analysis
showed the findings of 10 significant features that can achieve
a near-perfect recognition of 98.08%. The feature selection
approaches used in this research are the Chi-Square test, the
Minimum Redundancy Maximum Relevance (mRMR) test,
and the Recursive Feature Elimination test based on Random
Forest (RFE-RF). Also, the seven classifiers utilized in this
research are Decision Tree (DT), K-Nearest Neighbors (KNN),
Logistic Regression (LR), Naı̈ve Bayes (NB), Random Forest
(RF), Neural Network (NN), and Support Vector Machine (SVM).
Index Terms—Diabetes Classification, Chi-Square, mRMR,
Recursive Feature Elimination, Decision Tree, K-Nearest Neigh-
bors, Naı̈ve Bayes, Logistic Regression, Random Forest, Neural
Network, Support Vector Machine
Diabetes mellitus, popularly acknowledged as diabetes, is
a combination of metabolic disturbances distinguished by a
raised blood sugar volume over a lengthened period [8].
Signs usually involve repeated urination, amplified thirst,
and enhanced hunger. If neglected, diabetes may produce
numerous complexities [3]. Severe difficulties can involve
diabetic ketoacidosis, hyperosmolar hyperglycemic situation,
or even loss of life [9]. Severe long-term complexities involve
cardiovascular illness, stroke, chronic kidney disorder, foot
ulcers, injury to the nervures, loss of eye-sights, and cognitive
impairment [3], [10].
Diabetes is expected to either the pancreas not creating
sufficient insulin, or the cells of the body not reacting correctly
to the insulin created [11]. There are three foremost kinds of
diabetes. Type 1 diabetes is caused by the pancrea’s collapse to
create sufficient insulin because of the lack of beta cells. Type
2 diabetes starts with insulin opposition, a situation where cells
lose to reply to insulin correctly. Gestational diabetes is the
last main type and happens when pregnant women having no
past occurrences of diabetes exhibit high blood sugar volumes
[3].

I. I NTRODUCTION Although the effects of diabetes can be severe, early detec-

Approximately 463 million personalities became affected
by diabetes globally which is about 8.8% of the entire grown-
up population as of 2019 [1]. Occurrences of getting affected
are alike in both males and females [2]. Experimental analysis
implies that occurrences will proceed to increase [1]. Diabetes
at least increases a person’s chance of early mortality twice
[3]. Diabetes caused around 4.2 million deaths in 2019 [1]. It
is the 7th foremost reason of mortality worldwide [4], [5]. The
global financial expense of diabetes-associated health cost was
measured at US $727 billion in 2017 [1]. Diabetes required
almost US $327 billion in 2017 in the United States alone [6].
Average medicinal expenses amongst persons with diabetes
are approximately 2.3 times greater than that of the normal
persons [7]. Research in this field can contribute to the smart
health care sector which is a part of the fourth industrial
revolution.
tion of diabetes can decrease the mortality rate by a notable
margin. To detect diabetes at an early stage, previously, many
studies have been conducted. However, in this study, we
started with a dataset of 520 patients. We applied three feature
selection (FS) approaches and selected 10 features for each
of them. We also considered the common six features which
were selected for all three feature selection approaches. After
that seven machine learning classifiers were applied and per-
formances were measured in terms of sensitivity, specificity,
Matthews Correlation Coefficient (MCC), area under curve
(AUC) and overall accuracy. We concluded that Support Vector
Machine produced the highest accuracy of 98.08% while con-
sidering the 10 selected features selected by Recursive Feature
Elimination based on Random Forest which outperformed
the previous research. We also concluded that considering
common features doesn’t enhance the performance as well.
Fig. 1 illustrates the workflow diagram of our research.

978-0-7381-4246-3/20/$31.00 2020
c IEEE
 II. L ITERATURE R EVIEW
Previously, investigations have been conducted for the clas-
sification of diabetes. One of the best works was conducted
on a collected data of 865 patients with 9 attributes where
the considered variables were diabetes probability, 2h serum
insulin, number of times pregnant, diabetes pedigree type,
skin fold thick, plasma glucose, diastolic B.P, and sex [11].
Another study suggested an overall accuracy of 88.10% by
utilizing the Support Vector Machine and Linear Deterministic
Analysis algorithm together on a dataset of 738 patients
[12]. One research suggested Support Vector Machine as the
best classifier while applied on their dataset which consisted
of seven attributes: glucose, skin, blood pressure, insulin,
thickness, BMI, age, and diabetes pedigree function [13]. The
Bayesian Regulation algorithm was also utilized to achieve
88.8% accuracy on a dataset of 250 diabetes patients [14].
Promising research suggested Random Forest as the best
classifier while considering the Pima Indian Diabetes dataset
[15]. 70.8% accuracy was measured on a dataset of 318
records [16]. Recent research suggested an overall accuracy of
97.4% while utilizing 16 attributes on a dataset of 520 persons
applying Random Forest with ten fold cross validation (CV).
They also claimed an accuracy of 99% while keeping 100 Fig. 1: Proposed Workflow Diagram of this Research
samples in test data [17]. We worked with the same dataset
and achieved an overall accuracy of 98.08% with 10 attributes
in consideration which indicates that the accuracy achieved is
nearly same but we need only 10 attributes instead of all 16 one or more segments of a probability table. The measures
to classify the patients. are arranged into regularly exclusive collections. The null
hypothesis is true if there are no differences among the
III. M ATERIALS AND M ETHODS associations in the population, the test statistic discovered from
In this section, firstly, dataset description has been dis- the measures supports chi-square frequency correlations. The
cussed. After that the feature selection approaches and classi- goal of the test is to evaluate how properly the observed rates
fication methods have been presented. would be admitting the null hypothesis is true.

A. Dataset Description 2) Minimum Redundancy Maximum Relevance Test: Char-

The dataset considered in our research has reports of
diabetes-associated symptoms of 520 patients [17]. The dataset
was created from the answers and experimented results of the
diabetes-suspected patients from the Sylhet Diabetes Hospital
of Sylhet, Bangladesh. A total of 16 attributes were considered
in this dataset. The name and description of the attributes
have been illustrated in Table-I. The patients considered here
either because diabetic recently or was facing several or more
symptoms of diabetes.
B. Feature Selection Approaches
In this section, three feature selection approaches have been
considered. The feature selection methods considered in this
analysis are the Chi-square test, mRMR, and RFE-RF.
1) Chi-Square Test: A chi-squared test [18] is a mathemat-
ical and statistical hypothesis examination which is sufficient
to operate while the test statistic is chi-squared distributed un-
derneath the null hypothesis, especially Pearson’s chi-squared
test and corrections. Pearson’s chi-squared test is exercised to
resolve whether there is a statistically significant difference
among the expected outcomes and the observed outcomes in
acteristics can be determined in numerous techniques. One
design is to select features that describe the most to the
classification characteristics. This is defined as the maximum-
relevance choice. Various heuristic techniques can be exer-
cised, such as the subsequent forward, backward, or floating
arrangements. In contrast, characteristics can be selected to be
reciprocally different from each other while yet maintaining
a powerful relationship to the classification characteristics.
This system, termed as Minimum Redundancy Maximum
Relevance (mRMR) [19] selection has been recognized to be
more effective than the maximum relevance determination.
3) Recursive Feature Elimination Test Based on Random
Forest: Recursive Feature Elimination is a backward elim-
ination technique revealed on the thought of dropping the
most inadequate features at various levels [20]. We employed
Random Forests along with leave one out cross-validation
as assistant treatments for our investigation field. Random
forest was engaged as it keeps the high efficiency of a large
dimension of data. The purpose of cross-validation is to
develop a dataset to investigate the idea in the preparation
period to reduce obstacles such as overfitting.
 TABLE I: Description of the attributes of the dataset TABLE II: Selected features names and their ranks for the
Chi-Square test
Attributes Namea Values
Age 20-35, 36-45, 46-55, 56-65, above 65 Serial Feature Name Rank of the Feature
Sex Male, Female 1 Polyuria 0.708873364
Polyuria Yes, No 2 Polydipsia 0.671751811
Plydipsia Yes, No 3 Sudden Weight Loss 0.466224726
Sudden Weight Loss Yes, No 4 Partial Paresis 0.439970751
Weakness Yes, No 5 Gender 0.438866912
Polyphagia Yes, No 6 Polyphagia 0.334349197
Genital Thrush Yes, No 7 Irritability 0.275863424
Visual Blurring Yes, No 8 Alopecia 0.255654996
Itching Yes, No 9 Weakness 0.237047964
Irritability Yes, No 10 Visual Blurring 0.229085483
Delayed healing Yes, No
Partial Stiffness Yes, No TABLE III: Selected features names and their ranks for the
Alopecia Yes, No mRMR test
Obesity Yes, No
Class Positive, Negative Serial Feature Name Rank of the Feature
1 Polyuria 0.349081315
2 Gender 0.031224443
C. Machine Learning Classifiers 3 Polydipsia 0.096128258
In this segment, the seven classifiers, decision tree, k-nearest 4 Sudden Weight Loss 0.018500436
neighbors, logistic regression, Naı̈ve Bayes, support vector ma- 5 Partial Paresis 0.019691548
chine, random forest, and neural network (backpropagation), 6 Irritability 0.020782029
7 Polyphagia 0.007662441
have been presented.
8 Muscle Stiffness 0.008012016
1) Decision Tree: A decision tree is one of the most
9 Weakness 0.003855402
dependable predicting and classification systems. It is a 10 Obesity -0.001250334
flowchart-like tree structure. It is a supervised training al-
gorithm. By using tree representation, the algorithm tries
to resolve the dilemma. In the decision tree classifier, each been widely exercised in real-world classification puzzles and
center node symbolizes a test on a characteristic, each growth nonlinear function forecast challenges [25].
describes a result of the test and each end or leaf node restrains 6) Random Forest: Random Forest is a procedure for
a class label [21]. high dimensional data modeling as it can handle missing
2) K-Nearest Neighbor: It is an approach that is employed requirements and can maintain continuous, categorical, and
for both classification and regression. The primary role of this binary data. It is a process of procurement of information by
algorithm is to classify a new object based on features and constructing several decision trees. Random forest is a method
training samples. Which are the most nearby neighbors to the that can overcome the overfitting difficulty for bootstrapping
test individual is decided according to the k training samples, and ensemble composition [26].
this algorithm predicts the test sample’s level, and obtain the 7) Neural Network (Backpropagation): In the regions of
consequence that has the highest level possibility [22]. learning, backpropagation [27] is a broadly trusted supervised
3) Logistic Regression: Logistic Regression is a classifi- technique in training feedforward neural systems. In perform-
cation method that assists as a predictive analysis technique ing a neural system, backpropagation measures the slope of
and it is based on the concept of probability. It is applied to the loss function concerning the significance of the system for
classification difficulties. This algorithm produces a discrete an appropriate input-output case, and works efficiently unlike
binary consequence among 0 and 1 [23]. a straightforward calculation of the slope concerning every
4) Naı̈ve Bayes: Naive Bayes is an effective and robust load individually. That response makes it attainable to employ
learning algorithm for machine learning and data mining [24]. gradient techniques for training multilayer arrangements, re-
This algorithm is a combination of classification methods newing loads to decrease loss and gradient variants such as
based on Bayes Theorem. It is not a single algorithm but stochastic gradient descent are commonly applied.
a group of algorithms where all of them participate with
a common law, where every pair of characteristics being IV. E XPERIMENTAL A NALYSIS
investigated is independent of each other, hence, it is a class The dataset had a continuous feature. Firstly, that continuous
conditional independent algorithm. feature was normalized. Then, the dataset was split into the
5) Support Vector Machine: Support Vector Machine train set and test set where 80% of the data were considered
(SVM) is another type of classification procedure. SVM is for training and the rest 20% of the data were considered
a supervised machine learning algorithm that provides higher for testing. After that, we applied three feature selection
performance than other machine learning strategies and has techniques on the training dataset. The three feature selection
TABLE IV: Features selected by each of the feature selection algorithms (Boruta, Lasso, mRMR, RFE-RF and Chi-square
test)
Method Selected Features No. of Features
Polyuria, Polydipsia, Sudden Weight Loss, Partial Paresis, Gender, Polyphagia, Irritability,
Chi Square 10
Alopecia, Weakness, Visual Blurring
Polyuria, Gender, Polydipsia, Sudden Weight Loss, Partial Paresis, Irritability, Polyphagia,
mRMR 10
Muscle Stiffness, Weakness, Obesity
Polyuria, Polydipsia, Gender, Age, Delayed Healing, Alopecia, Irritability,
RFE-RF 10
Sudden Weight Loss, Partial Paresis, Itching
Common in these
Polyuria, Polydipsia, Sudden Weight Loss, Partial Paresis, Gender, Irritability 6
3 FS methods

TABLE V: Performance of classifiers for each of the nine scenarios in terms of accuracy, sensitivity, specificity, Matthews
correlation coefficient (MCC), F1-score, and area under curve (AUC) value
Classifiers Name Overall Accuracy Sensitivity Specificity MCC Value F1-score AUC Value
Chi-square Test
DT 0.90385 0.87500 0.95000 0.80813 0.91803 0.91250
KNN (k=5) 0.91346 0.90625 0.92500 0.82121 0.92800 0.91560
LR 0.85577 0.89063 0.80000 0.69402 0.88372 0.84530
NB 0.83654 0.84375 0.82500 0.66067 0.86400 0.83440
NN 0.92308 0.90625 0.95000 0.84318 0.93548 0.92810
RF 0.93269 0.92188 0.95000 0.86134 0.94400 0.93590
SVM(RBF) 0.95192 0.95313 0.95000 0.89910 0.96063 0.95156
mRMR Feature Selection
DT 0.93269 0.92188 0.95000 0.86134 0.94400 0.93594
KNN (k=9) 0.86538 0.85938 0.87500 0.72316 0.88710 0.86720
LR 0.86538 0.90625 0.80000 0.71353 0.89231 0.85310
NB 0.82692 0.82813 0.82500 0.64315 0.85484 0.82660
NN 0.94231 0.93750 0.95000 0.87997 0.95238 0.94380
RF 0.92308 0.89063 0.97500 0.84792 0.93443 0.93280
SVM(RBF) 0.94238 0.92188 0.97500 0.88318 0.95161 0.94844
RFE-RF Feature Selection
DT 0.91346 0.85938 1.00000 0.83757 0.92437 0.92969
KNN (k=5) 0.90385 0.92188 0.87500 0.79688 0.92188 0.89840
LR 0.86538 0.85938 0.87500 0.72316 0.88710 0.86720
NB 0.83654 0.84375 0.82500 0.66067 0.86400 0.83440
NN 0.89423 0.82813 1.00000 0.80592 0.90598 0.91410
RF 0.94231 0.92188 0.97500 0.88318 0.95161 0.94840
SVM(RBF) 0.98077 0.98438 0.97500 0.95938 0.98438 0.97969
Common in Chi-square, mRMR and RFE-RF
DT 0.88462 0.85938 0.92500 0.76834 0.90164 0.89219
KNN (k=5) 0.87500 0.84375 0.92500 0.75148 0.89256 0.88440
LR 0.85577 0.87500 0.82500 0.69688 0.88189 0.85000
NB 0.83654 0.84375 0.82500 0.66067 0.86400 0.83440
NN 0.88462 0.85938 0.92500 0.76834 0.90164 0.89220
RF 0.86535 0.89063 0.82500 0.71563 0.89063 0.85750
SVM(RBF) 0.89423 0.87500 0.92500 0.78556 0.91057 0.90000

techniques used in this research are the Chi-square test, the
minimum Redundancy Maximum Relevance (mRMR) test,
and Recursive Feature Elimination based on Random Forest
(RFE-RF) test. The features were selected based on the rank
of the features. Different feature selection classifiers ranked
the features in different serials. Table-II denotes the ranks of
the variables calculated by the Chi-square test.
Table-III illustrates the rank of the top 10 features calculated
by the mRMR test. For all the feature selection approaches,
the top 10 features were taken under consideration. Table-
IV illustrates the features selected by the Chi-square test,
mRMR test, and RFE-RF test. Moreover, Table-IV also shows
the six common features selected by all three feature selec-
tion approaches as well. After that, seven machine learning
classifiers were utilized for features selected by each of the
feature selection approaches and for the six common features.
The seven classifiers considered in this research are Deci-
sion Tree, K-Nearest Neighbors, Logistic Regression, Naı̈ve
Bayes, Neural Network (Back Propagation), Random Forest,
and Support Vector Machine with Radial Basis Kernel(RBF).
The performance of the classifiers was measured with the
assistance of some performance measurement techniques e.g.
sensitivity, specificity, MCC value, F1-score, AUC value, and
overall accuracy.
TABLE VI: Comparison in terms of accuracy and selected
features between proposed approach and previous approaches
Study Number of Features Accuracy
RF (10 Fold CV) [17] 16 97.40%
RF (percentage split) [17] 16 99.00%
Proposed Approach 10 98.08%
Table-V illustrates the performances of the classifiers for
each of the scenarios. It can be observed that the highest
accuracy achieved by the selected features of the Chi-square
test is 95.19% for the Support Vector Machine classifier. The
overall accuracy of 94.23% was achieved by utilizing the
features selected by the mRMR test for the Support Vector
Machine classifier. However, an overall accuracy of 98.08%
was achieved by utilizing the features selected by the RFE-RF
test for the Support Vector Machine classifier. The common
features selected by all three classifiers didn’t produce a good
result compared to the other feature selection approaches. The
common features produced the highest accuracy of 89.42% for
the Support Vector Machine Classifier as well.
Recent work on the same dataset provided an overall
accuracy of 97.4% for the Random Forest classifier with
cross validation where all of the 16 features form the dataset
was utilized for the classification [17]. In our research, we
utilized only 10 features selected by the RFE-RF test and
achieved an accuracy of 98.08% which outperformed the
previous work. The same previous investigation suggested an
accuracy of 99% while taking 100 samples in the test set [17].
However, our investigation minimized the information needed
for early classification of diabetes among patients which will
eventually result in a more cost-effective and nearly accurate
classification process. Table-VI illustrates the comparison with
the previous study.
V. C ONCLUSION
Being the seventh largest cause of death, diabetes detection
in the early stage has been an area of research for a decade
now. Previously, many works suggested different methods on
different datasets for the accurate recognition of the disease
at an early stage. While most of the studies achieved a near
accurate accuracy, the consideration of significant attributes
still lacks proper investigation. In this study, we considered a
publicly available dataset and applied three feature selection
approaches. We also considered all the six common features
selected by all three feature selection techniques. After that, we
applied seven machine learning classifiers and concluded that
Support Vector Machine can achieve a near-perfect accuracy
of 98.08% with only 10 features selected by the RFE-RF
approach. We hope that our research will be beneficial for
the development of a diabetes recognition system and will
decrease the mortality rate.
VI. ACKNOWLEDGEMENT
We are grateful to the Green University of Bangladesh for
financing this research.
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