A novel method to derive personalized minimum viable recommendations for type 2 diabetes prevention based on counterfactual explanations

Lenatti M., Carlevaro A., Guergachi A., Keshavjee K., Mongelli M., Paglialonga A.

PLoS ONE, vol.17, no.11 November, 2022 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 17 Issue: 11 November
  • Publication Date: 2022
  • Doi Number: 10.1371/journal.pone.0272825
  • Journal Name: PLoS ONE
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, Agricultural & Environmental Science Database, Animal Behavior Abstracts, Aquatic Science & Fisheries Abstracts (ASFA), BIOSIS, Biotechnology Research Abstracts, Chemical Abstracts Core, EMBASE, Food Science & Technology Abstracts, Index Islamicus, Linguistic Bibliography, MEDLINE, Pollution Abstracts, Psycinfo, zbMATH, Directory of Open Access Journals
  • TED University Affiliated: No


Copyright: © 2022 Lenatti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Despite the growing availability of artificial intelligence models for predicting type 2 diabetes, there is still a lack of personalized approaches to quantify minimum viable changes in biomarkers that may help reduce the individual risk of developing disease. The aim of this article is to develop a new method, based on counterfactual explanations, to generate personalized recommendations to reduce the one-year risk of type 2 diabetes. Ten routinely collected biomarkers extracted from Electronic Medical Records of 2791 patients at low risk and 2791 patients at high risk of type 2 diabetes were analyzed. Two regions characterizing the two classes of patients were estimated using a Support Vector Data Description classifier. Counterfactual explanations (i.e., minimal changes in input features able to change the risk class) were generated for patients at high risk and evaluated using performance metrics (availability, validity, actionability, similarity, and discriminative power) and a qualitative survey administered to seven expert clinicians. Results showed that, on average, the requested minimum viable changes implied a significant reduction of fasting blood sugar, systolic blood pressure, and triglycerides and a significant increase of high-density lipoprotein in patients at risk of diabetes. A significant reduction in body mass index was also recommended in most of the patients at risk, except in females without hypertension. In general, greater changes were recommended in hypertensive patients compared to non-hypertensive ones. The experts were overall satisfied with the proposed approach although in some cases the proposed recommendations were deemed insufficient to reduce the risk in a clinically meaningful way. Future research will focus on a larger set of biomarkers and different comorbidities, also incorporating clinical guidelines whenever possible. Development of additional mathematical and clinical validation approaches will also be of paramount importance.