Machine Learning analysis in the prediction of
diabetes mellitus: a systematic review of the
literature
Abstract— In recent years, diabetes mellitus has increased
its prevalence in the global landscape and currently, due to
COVID-19, people with diabetes mellitus are the most likely to
develop a critical picture of this disease, which is why early
diagnosis is so important and where the implementation of
machine learning has played a vital role in recent years. In this
study we conducted a systematic review of 55 researches where
models focused on the prediction of diabetes mellitus and its
different types have been developed or implemented, these
articles have been retrieved from important databases such as
IEEE Xplore, Scopus, ScienceDirect, IOPscience, EBSCOhost,
Wiley. The results obtained show that one of the models based
on Support Vector Machine algorithms achieved 100%
accuracy in disease prediction. The vast majority of researches
used Wekka platform as a modeling tool, but it is worth
mentioning that the models with the best performance were
developed in MATLAB (100%) and RStudio (99%). On the
other hand, researches seek to predict diabetes without
specifying the type, however, there are a considerable number
of articles that predict type 2 diabetes.
Keywords—Diabetes Mellitus, Diabetes Types, Diabetes
Gestational, Machine Learning, Systematic review
I. INTRODUCTION
Over the years, diabetes has become a global public health
problem. Recent studies show that more than 381 million
people over the age of 18 suffer from diabetes and that
approximately 45.8% of them have not yet been diagnosed.
[1].
This disease is classified into 3 types. Type 1 diabetes which
is caused by insulin deficiency. Type 2 diabetes is caused by
varying degrees of insulin resistance, altered insulin
secretion, increased glucose production and various genetic
metabolism defects in the action of insulin. Finally,
gestational diabetes occurs in women during pregnancy. [2]
Now, most physicians would agree that this disease, largely
related to one's lifestyle, can be prevented, unfortunately, the
medical community has been largely absent from the battle to
improve these conditions. In fact, numerous studies show that
physicians often discuss weight management, physical
activity, or proper nutrition in <40% of the people they see in
their offices. [3]
XXX-X-XXXX-XXXX-X/XX/$XX.00 ©20XX IEEE
In recent years, humanity has been immersed in health
problems, especially in low-income environments, and the
situation is aggravated by the limited capacity of the health
system [4] This is why it is important to develop and
implement technologies such as machine learning models
that serve as tools for doctors and patients, through preventive
medicine that can help diagnose patients early and provide
them with health advice.
The aim of this article is to analyze and to make known the
presence of machine learning models to detect and predict
diabetes mellitus and its types. This article aims to provide an
analytical summary based on research conducted in different
countries around the world in the last 4 years.
II. METODOLOGY
A. Type of study
For the preparation of the article, the systematic review of
the scientific literature will be used; this is a process that
allows the collection of relevant evidence on a given topic, in
addition, it adjusts to the established eligibility criteria, which
allows obtaining answers to the research questions
formulated. [5]
B. Research questions
The proposed research questions are as follows:
RQ1 Which diabetes mellitus prediction models have shown
the best results according to performance metrics over the
past 4 years?
RQ2: Which tools and languages are the most widely used in
the world to develop or implement machine learning models
for diabetes mellitus prediction?
RQ3: Which countries has the most research related to the
prediction of diabetes mellitus been conducted in the last 4
years?
RQ4: What type of diabetes mellitus has had the highest
amount of scientific research focused on prediction with
machine learning worldwide?
C. Search strategies Inclusion I02 Articles related to the application or
implementation of machine learning models
Based on the questions posed, an exhaustive search of for the prediction of diabetes mellitus.
articles published in the main databases such as IEEEXplore,
I03 Articles related to the prediction of type 1
Scopus, ScienceDirect, IOPscience, EBSCOhost and Wiley diabetes, type 2 diabetes or gestational
were carried out, from which 683 scientific articles from the diabetes using machine learning.
last 4 years were collected. E01 Articles unrelated to the development of
machine learning models for the prediction of
The following formulas were used to search for diabetes- diabetes mellitus.
related research: E02 Articles unrelated to the implementation of
Exclusion machine learning models for diabetes
TABLE I. SEARCH EQUATIONS prediction.
E03 Articles unrelated to the prediction of type 1
Data Base Equation diabetes, type 2 diabetes or gestational
IEEE Xplore prediction of diabetes by machine learning NOT diabetes using machine learning.
deep learning NOT risk
Scopus prediction AND of AND diabetes AND by AND
machine AND learning AND NOT deep
learning" AND NOT risk A total of 683 articles were analyzed, of which 3 duplicate
ScienceDirect diabetes AND machine learning AND predict articles were discarded. Then, 55 articles were selected,
model NOT deep learning NOT drug excluding 628 according to the exclusion criteria and which
IOPscience diabetes AND machine learning AND predict did not contribute to answering the research questions. This
model resulted in 55 articles for the systematic review.
EBSCOhost prediction of diabetes by machine learning NOT
deep learning NOT risk
Wiley prediction of diabetes by machine learning NOT
deep learning NOT risk
Articles identified through Articles identified through
IDENTIFICATION
database searching other sources
In order to make an optimal selection of research, search (n = 683) (n = 0)
formulas and key words were applied, as well as inclusion
and exclusion criteria, and finally, discarding due to
duplicity, obtaining 55 relevant papers.
Articles after duplicates
removed (n = 680)
78 22

IEEE
SCREENING

162 15 Articles to be Articles excluded

Applying exclusion and inclusion criteria

screened (n=80) (n= 625)

Search by formulas and keywords

SCOPUS
Did not meet the
331 12 inclusion criteria
Duplicate Removal

ScienceDirect TOTAL
55
Papers
ELIGIBILITY

74 2
relevant
IOPscience Articles assessed for Articles excluded with
eligibility (n=55) reasons (n= 0)
18 2
Did not address the
EBSCOhost research question

20 2
INCLUDED

Wiley Articles included in

quantitative synthesis
(meta-analysis) (n = 55)
Figure 1. Selection methodology diagram

D. Inclusion and Exclusion criteria Figure 2. Document Inclusion and Exclusion Flowchart
Inclusion and exclusion criteria presented in the following
table were applied for the systematic review study.

TABLE II. INCLUSION AND EXCLUSION CRITERIA III. RESULTS

Criteria
I01 Articles related to the development or
performance comparison of diabetes mellitus
prediction models.
 The following graph represents the percentage
contribution of each of the databases in this review.
TABLE III. ARTICLES BY COUNTRY

4% 3% Country Quantity Articles

27% Saudi Arabia 1 [6]

40% EBSCOhost
Bangladesh 1 [7]
IEEE Xplore
China 4 [8],[9],[10],[11]
IOPScience
Korea 1 [12]
ScienceDirect
United Arab
22% 4% SCOPUS 1 [13]
Emirates
WILEY
India [2],[14],[15],[16],[17],[18],[19],[20],[21
],[22],[23],[24],[25],[26],[27],[28],[29],
Figure 3. Contribution by Database 32
[30],[31],[32],[33],[34],[35],[36],[37],[3

The following graph represents the number of 8],[39],[40],[41],[42],[43],[44]

published articles focused on developing and/or evaluating Indonesia 3 [45],[46],[47]
mathematical models that allow the prediction of diabetes in
the world by year and database. England 1 [1]

Israel 1 [48]
9
Italy 1 [49]
8
North
7 1 [50]
Macedonia
6
Morocco 1 [51]
5
Pakistan 1 [52]
4
Poland 1 [53]
3
USA 5 [54],[55],[56],[57],[58]
2
1 Total 55

0
2018 2019 2020 2021 The following graph represents the number of articles
EBSCOhost IEEE Xplore published by continent, where Asia is predominant.
IOPScience ScienceDirect
SCOPUS WILEY

Africa 1
Figure 4. Articles by year and database

The following graph shows the number of articles by country, America 5

with the countries that have published the largest number of
scientific research papers being shown with greater intensity.
Europe 4

Asia 45

0 10 20 30 40 50

Figure 6. Articles by continent

The following graph represents the number of articles by

database and type of diabetes.

Figure 5. Map of articles by country

 25 The following graph represents the number of items per
machine learning algorithm used in the research.
20
AdaBoost 1
15 C4.5 1
Convolutional Neural Networks 1
Decision Tree 2
10 Decision Tree+Neural network 1
Extreme Learning Machine 1
Glmnet 1
5 Gradient Boost 2
Gradient Boosted Trees 1
K-Nearest Neighbor 3
0 Logistic Model Tree 1
EBS IEE IOP Scie SCO WIL Logistic Regression 3
COh E Scie nceD PUS EY Modified Support Vector… 1
ost Xplo nce irect Naive Bayes 3
re Neural Networks 8
Type 1 2 Random Forest 10
RBF + C4.5 + NB 1
Gestational 2 1 1 Support Vector Machine 10
Tree Partitioning Adaptive… 1
Type 2 2 7 1 6 4 Two-class Logistic Regression 1
Diabetes 13 1 5 9 1 XGBoost 2
0 2 4 6 8 10 12
Figure 7. Articles by database and type of diabetes
Figure 9. Articles by machine learning algorithm

The following table shows the categories of items according

to the results found. The following graph shows the articles according to metrics
identified in the research articles.
TABLA IV. ARTICLES BY TYPE OF DIABETES
Accuracy 51
Categories Articles Precision 21
Recall 18
Type 1 Diabetes Mellitus [49], [8] Specificity 13
[50], [54], [14], [15], [16], [19], Sensitivity 12
[20], [32], [33], [35], [36], [57], AUC 10
Type 2 Diabetes Mellitus ROC 8
[12], [38], [58], [6], [47], [52], F-Measure 8
[42], [43] F1-Score 8
Gestational Diabetes Error Rate 5
[2], [13], [9], [41] MCC 3
Mellitus FP-Rate 3
[1], [55], [17], [45], [18], [21], [56], [7], Cross Validation 3
Diabetes Mellitus (Type is [22], [23], [24], [46], [25], [26], [51], Otros 1
not specified) [27], [28], [29], [30], [31], [34], [37], 0 10 20 30 40 50 60
[48], [10], [39], [40], [53], [11], [44] Figure 10. Articles by evaluation metrics

The following graph represents the number of items per

According to the metrics chart, accuracy is the most recurrent
dataset used for the development of the models.
metric, based on which we show the models with the best
performance according to the indicated metric.
1
Other Datasets
2
UCI Datasets TABLE V. MODELS WITH BETTER ACCURACY
4
Institutions and Foundations 7 Model Accuracy Article
32
Own Datasets 9 Support Vector
100% [49]
Machine
Hospitals, Clinics and…
Random Forest 99% [30]
PIMA Indian Diabetes Extreme Learning
99% [28]
0 10 20 30 40 Machine

Figure 8. Articles by dataset

The following graph represents the number of articles per identify the best machine learning models, the most frequent
model development tool used in the research. implementation tools, as well as the largest amount of
research according to the type of diabetes and countries, in
order to answer the proposed questions:
35 31
RQ1 Which diabetes mellitus prediction models have
30 shown the best results according to performance metrics
25 over the past 4 years?
20
Figure 10 shows that most of the articles analyzed in this
15 review use Accuracy as a metric to evaluate their models. The
10 result obtained allows us to use this metric as a reference to
10
4 identify the models with the best performance.
4
5 1 1 1 1 2
0
According to Table V, it can be seen that the Support Vector
Machine, Random Forest and Extreme Learning Machine
models have obtained the best performance with 100%, 99%
and 99% accuracy, respectively.

It is important to mention that according to Figure 9, it is

Figure 11. Articles by model development tool shown that the Support Vector Machine and Random Forest
models are the models most used by researchers.

The following graph represents the number of articles by RQ2: Which tools and languages are the most widely used
programming language used in the research, where the in the world to develop or implement machine learning
language. models for diabetes mellitus prediction?

According to Figure 11, it can be seen that of all the articles

analyzed in this review, although most of the researchers do
12 not indicate the development environment of their models, a
large number use the free software platform Weka as their
modeling, visualization and data analysis tool, which is
23
described by all the authors as a simple and intuitive tool that
4 makes it much easier to carry out the aforementioned tasks.
1
Furthermore, according to Figure 12, it can be seen that
10 Graphical User Interfaces (GUI) are more used for modeling
4 1 than the programming languages themselves.

It is worth mentioning that according to Table VI, the

GUI M PHP/JavaScript… Python Python/R R No indica MATLAB tool, in which the M language is used, is the one
Figure 12. Articles by programming language with the highest accuracy (100%) when developing a
machine learning model (Support Vector Machine), followed
by R Studio with the R language in which, when developing
The following table shows the tools and languages used in the the Random Forest model, an accuracy of 99% was obtained.
research with the highest performing models
RQ3: Which countries has the most research related to
the prediction of diabetes mellitus been conducted in the
TABLE VI. TOOLS AND LANGUAGES ACCORDING TO last 4 years?
MODELS WITH BETTER ACCURACY
Figure 4, manifests that in the last four years (2018-2021)
Tool Lenguage Model Accuracy Artículo
there is an increasing amount of research related to diabetes
Support
Lenguaje mellitus prediction, between 2019 and 2020 a great variety of
MATLAB Vector 100% [49]
M publications were made especially in the IEEE Xplore
Machine
R Studio R
Random
99% [30] databases followed by Scopus, this result is supported by
Forest Figure 3. This indicates that there is a preference by
Extreme
MATLAB
Lenguaje
Learning 99% [28] researchers to make their scientific publications related to
M diabetes prediction in the aforementioned databases.
Machine

According to Figure 6, it is shown that all the articles

IV. DISCUSSION analyzed in the present review come from the continents of
In this systematic investigation of the scientific literature, we Asia, North America, Europe and Africa (from highest to
analyze machine learning models for diabetes prediction, lowest). This result indicates that the development of
machine learning models for the prediction of diabetes
mellitus is a recurrent research topic almost all over the
world.
According to Figure 5 and Table III, it is shown that the vast
majority of research is conducted in India followed by China.
This result indicates that it is in these countries where there is
more experience in the development of machine learning
models for the prediction of diabetes mellitus, therefore, it is
important to include research from the identified countries in
future studies.
RQ4: What type of diabetes mellitus has had the highest
amount of scientific research focused on prediction with
machine learning worldwide?
According to Table IV, it can be seen that of all the articles
analyzed in the present review, more research does not focus
on a specific type of diabetes mellitus, but it can also be seen
that there is a significant number of research that seeks to
predict type 2 diabetes mellitus, and a small group focuses on
gestational diabetes and type 1 diabetes.
Figure 7 shows that in almost all the databases consulted for
this review, at least one research related to the prediction of
diabetes mellitus was found. This result indicates that, in the
most important scientific databases, research on the
development of models for the prediction of diabetes mellitus
is relevant.
In addition, Figure 8 shows that, of all the articles analyzed,
the vast majority of the research has used the PIMA Indian
Diabetes dataset for training prediction models and it is also
observed that there is a minority that generates its own
dataset. This result indicates that the information provided by
this dataset is highly valued by researchers and is related to
the fact that there is a greater amount of research on predictive
models for type 2 diabetes and gestational diabetes because
the variables in these data are identified as determinants for
the prediction of the mentioned types.
RELATED TAKS
Other systemic review studies conducted such as [59] focus
on analyzing diabetes predictions based on machine learning
and deep learning techniques published in the last six years
(2013 to 2019), where the main datasets were identified as:
Electrocardiograms, Breath Dataset, ICU Datasets, PIMA
Indian Diabetes, with the latter being predominant. Likewise,
the article determined that the most used classifiers for
diabetes prediction are: Artificial Neural Network (ANN),
Support Vector Machine (SVM), Decision Tree, and Naive
Bayes.
In research 60, 31 articles were selected to identify the
applications of artificial intelligence (AI) for the care of type
2 diabetes mellitus, and the main applications of AI for the
care of type 2 diabetes mellitus were screening and diagnosis.
Among all the AI methods reviewed, machine learning
methods were the most applied techniques and the most used
methods were: Support Vector Machine and Naive Bayes. In
the same way, the most important variables used in the
selected studies for the prediction of type 2 diabetes were
identified.
On the other hand, in contrast to our target group of articles,
the systemic review [61], aims to evaluate the use and
performance of ML prediction models applied in community
settings for early detection of risk groups. In this research,
studies conducted in hospitals, primary care centers and
laboratories were excluded. Twenty-three articles published
between 2009 and 2019 were taken into account for the
research. It was found that models based on Artificial Neural
Network showed the highest predictive capacity, followed by
Logistic Regression, Decision trees and Random Forest.
In the present study, 55 articles were selected to identify the
most used machine learning models as in other studies, in
addition we recognize the ML models for diabetes prediction
with better performance according to the metrics
recommended by numerous studies, as the most used
development or implementation tools, as well as the largest
amount of research according to type of diabetes and
countries. We agree with the study [59] in identifying the
most used dataset, which is PIMA Diabetes India as shown in
Figure 8, with reference to the most used models according
to Figure 9 we have: Artificial Neural Network (ANN),
Support Vector Machine (SVM), Random Forest, in which
we agree in two models with respect to the results of the
article [59] and in one model with the study [60]. Regarding
the ML models with better performance according to the
accuracy metric, we agree in one model with the article. [61]
V. CONCLUSIONS
After having carried out a systematic investigation of the
scientific literature of 55 articles related to the topic in
question, it is concluded that:
The prediction models of diabetes mellitus that have
presented better results in the last 4 years are Support Vector
Machine (100%), Random Forest (99%) and Extreme
Learning Machine (99%), according to Accuracy, which was
defined as a metric to identify the best models due to its
presence in most researches where they consider it as a
determinant metric.
The tools and languages with which machine learning models
are usually developed or implemented worldwide are the free
software platform Weka, for its ease of use, as well as
MATLAB, in which the M language is used, followed by R
Studio with the R language, these last two tools managed to
develop models that obtained the highest scores according to
Accuracy.
The vast majority of research is conducted in India followed
by China. This result indicates that it is in these countries
where there is greater experience and preference for the
development of predictive models for diabetes.
Likewise, there is a greater number of studies that do not
focus on a specific type of diabetes mellitus, but it is also
observed that there is an important number of studies that
seek to predict type 2 diabetes mellitus.
Based on the results obtained, it is recommended for future
research within the scope of this review, to work on the
development of predictive models with the Support Vector
Machine algorithm due to the good results obtained, as well
as to consider accuracy as a metric to evaluate model
performance and to use MATLAB or R Studio as
development tools.
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