Key Points Question Can a machine learning model trained on routinely collected administrative health data be used to accurately predict the onset of type 2 diabetes at the population level? Findings In this decision analytical model study of 2.1 million residents in Ontario, Canada, a machine learning model was developed with high discrimination, population-level calibration, and calibration across population subgroups. Meaning Study results suggest that machine learning and administrative health data can be used to create population health planning tools that accurately discriminate between high- and low-risk groups to guide investments and targeted interventions for diabetes prevention.

Across jurisdictions, government and health insurance providers hold a large amount of data from patient interactions with the healthcare system. We aimed to develop a machine learning-based model for predicting adverse outcomes due to diabetes complications using administrative health data from the single-payer health system in Ontario, Canada. A Gradient Boosting Decision Tree model was trained on data from 1,029,366 patients, validated on 272,864 patients, and tested on 265,406 patients. Discrimination was assessed using the AUC statistic and calibration was assessed visually using calibration plots overall and across population subgroups. Our model predicting three-year risk of adverse outcomes due to diabetes complications (hyper/hypoglycemia, tissue infection, retinopathy, cardiovascular events, amputation) included 700 features from multiple diverse data sources and had strong discrimination (average test AUC = 77.7, range 77.7–77.9). Through the design and validation of a high-performance model to predict diabetes complications adverse outcomes at the population level, we demonstrate the potential of machine learning and administrative health data to inform health planning and healthcare resource allocation for diabetes management.