Prediction of Diabetes Among Homeless Adults Using Artificial Intelligence: Suggested Recommendations

<b>Background:</b> Diabetes mellitus is a global health challenge, especially among homeless people. Early prediction of diabetes can reduce treatment costs and improve interventions. This study aimed to identify predictors of diabetes among homeless adults by utilizing artificial intelligence and providing recommendations for diabetes prevention. <b>Methods:</b> A case-control study of 150 homeless adults in Giza, Egypt (99 diabetes cases and 51 controls), analyzed 43 variables collected through interviews and physiological measures, with missing data imputed. Feature selection using recursive feature elimination and univariate and correlation analyses reduced the predictors to 13 variables. The class imbalance was addressed using synthetic minority over-sampling on the training set. Six models and a stacking ensemble with XGBoost as a meta-learner were evaluated using 5-fold cross-validation and performance metrics, including the accuracy, precision, recall, F1-score, and AUC-ROC. <b>Results:</b> The key predictors included BMI, systolic blood pressure, triceps skinfold thickness, waist circumference, lifestyle factors, comorbidities, diastolic blood pressure, age, medication adherence, educational level, marital status, duration of residence, and diabetes knowledge. Individual classifiers achieved a moderate performance (accuracy: 56.7-70.0%, F1-score: 0.686-0.781). The stacking ensemble substantially outperformed individual models, achieving a 95.45% accuracy, a 100% precision, a 93.75% recall, a 0.968 F1-score, and a 0.979 AUC-ROC on the test set. <b>Conclusions:</b> Machine learning models can reliably predict diabetes. The proposed hybrid stacking model outperformed conventional classifiers in terms of the prediction performance, highlighting the benefits of ensemble learning and sophisticated resampling strategies in dealing with imbalanced medical data. It is recommended that healthcare institutions integrate AI-powered diagnostic assistance technology into clinical processes to aid in the early detection and treatment of diabetes.