Cardiovascular Risk Stratification in Youth-Onset Type 2 Diabetes Using Machine Learning

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Gradient boosting model achieved 81% accuracy for arterial stiffness and 92% accuracy for atherosclerosis prediction

• Primary Outcome: Machine learning model accuracy for predicting arterial stiffness and atherosclerosis risk

• Nnt Or Sensitivity: Sensitivity and specificity values not provided for the prediction models

• Confidence Interval: Not reported

Clinical Application

Requires access to baPWV and cIMT measurements, which are available in major Australian diabetes centres Relevant to Australian practice given rising youth-onset T2DM; however, validation in Australian population needed before implementation. Could inform RACGP diabetes management guidelines for young adults Youth and young adults with type 2 diabetes requiring cardiovascular risk stratification

Abstract

BACKGROUND: The rising incidence of youth-onset type 2 diabetes mellitus (T2DM), along with the risk of early cardiovascular complications, is concerning. Brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (cIMT) are noninvasive markers of arterial stiffness and atherosclerosis. They serve as important markers for cardiovascular risk assessment. This study aimed to apply machine learning models to identify high-risk individuals who may benefit from early and targeted cardiovascular screening. METHODS: This retrospective study included 129 patients with youth-onset T2DM who underwent baPWV and cIMT measurements between January 2018 and July 2024. High-risk groups were defined as having values of ≥ mean + 1 standard deviation for baPWV (arterial stiffness) and cIMT (atherosclerosis). Clinical predictors were evaluated using linear, logistic regression, and machine learning analyses. Multiple machine learning models were trained using oversampling and cross-validation techniques to enhance prediction performance. RESULTS: Among the models tested, the gradient boosting model with adaptive synthetic sampling oversampling achieved the best performance in predicting both arterial stiffness (accuracy 0.81) and atherosclerosis prediction (accuracy 0.92). Age and hypertension were consistently identified as the most important factors for arterial stiffness. For atherosclerosis risk, traditional analysis identified dyslipidemia, male sex, and duration of illness as relevant factors; machine learning more clearly emphasized low-density lipoprotein cholesterol and triglyceride levels as key predictors of increased cIMT. CONCLUSION: Hypertension and age were consistent predictors of arterial stiffness, while atherosclerosis risk factors were further clarified with lipid parameters by machine learning analysis. These findings suggest that conventional and machine learning analyses offer complementary strengths. Their combined use may enable earlier to detect nuanced cardiovascular risk patterns and support early and targeted vascular screening in youth-onset T2DM.

References

1. 1.Joo, E. Y., Lee, Y. S., Shin, E. J., Kim, S. J., & Lee, J. E. (2026). Cardiovascular Risk Stratification in Youth-Onset Type 2 Diabetes Using Machine Learning. Journal of Korean Medical Science, 41, e4. https://doi.org/10.3346/jkms.2026.41.e4