AI Machine Learning–Based Diabetes Prediction in Older Adults in South Korea: Cross-Sectional Analysis

Background: Diabetes is prevalent in older adults, and machine learning algorithms could help predict diabetes in this population. Objective: This study determined diabetes risk factors among older adults aged ≥60 years using machine learning algorithms and selected an optimized prediction model. Methods: This cross-sectional study was conducted on 3084 older adults aged ≥60 years in Seoul from January to November 2023. Data were collected using a mobile app (Gosufit) that measured depression, stress, anxiety, basal metabolic rate, oxygen saturation, heart rate, and average daily step count. Health coordinators recorded data on diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, percent body fat, and percent muscle. The presence of diabetes was the target variable, with various health indicators as predictors. Machine learning algorithms, including random forest, gradient boosting model, light gradient boosting model, extreme gradient boosting model, and k-nearest neighbors, were employed for analysis. The dataset was split into 70% training and 30% testing sets. Model performance was evaluated using accuracy, precision, recall, F1 score, and area under the curve (AUC). Shapley additive explanations (SHAPs) were used for model interpretability. Results: Significant predictors of diabetes included hypertension (χ²1=197.294; P<.001), hyperlipidemia (χ²1=47.671; P<.001), age (mean: diabetes group 72.66 years vs nondiabetes group 71.81 years), stress (mean: diabetes group 42.68 vs nondiabetes group 41.47; t3082=-2.858; P=.004), and heart rate (mean: diabetes group 75.05 beats/min vs nondiabetes group 73.14 beats/min; t3082=-7.948; P<.001). The extreme gradient boosting model (XGBM) demonstrated the best performance, with an accuracy of 84.88%, precision of 77.92%, recall of 66.91%, F1 score of 72.00, and AUC of 0.7957. The SHAP analysis of the top-performing XGBM revealed key predictors for diabetes: hypertension, age, percent body fat, heart rate, hyperlipidemia, basal metabolic rate, stress, and oxygen saturation. Hypertension strongly increased diabetes risk, while advanced age and elevated stress levels also showed significant associations. Hyperlipidemia and higher heart rates further heightened diabetes probability. These results highlight the importance and directional impact of specific features in predicting diabetes, providing valuable insights for risk stratification and targeted interventions. Conclusions: This study focused on modifiable risk factors, providing crucial data for establishing a system for the automated collection of health information and lifelog data from older adults using digital devices at service facilities.