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原文摘要

Detecting diabetes risk early is important for preventing disease progression. Most existing machine learning approaches focus on binary classification, which limits their ability to capture intermediate risk states such as prediabetes. We develop a supervised learning framework to classify adults as normal, prediabetic, or diabetic using National Health and Nutrition Examination Survey data. The framework uses routinely collected demographic, clinical, and lifestyle variables from 15,356 adults, with glycated hemoglobin (HbA1c) used only to define labels and excluded from input features to prevent leakage. We compare conventional machine learning and transformer-based models and examine two binary formulations: normal versus prediabetes, and normal versus combined prediabetes and diabetes. Models are evaluated on a held-out test set using precision, sensitivity, specificity, and F1 score. In the multiclass setting, performance is broadly consistent across models, with accuracy up to 0.72 and macro-averaged F1 of 0.70. Prediabetes remains the most challenging class, with F1 scores of 0.54 to 0.56 for conventional models and 0.53 to 0.55 for transformers, reflecting its overlap with both neighboring states. When the task is reduced to normal versus prediabetes, F1 scores rise modestly to 0.62 to 0.64. A more substantial improvement is observed under a broader screening formulation combining prediabetes and diabetes, with F1 scores of 0.73 to 0.74 across all models. These findings suggest that feature overlap along the biological continuum between normal and diabetic states contributes more to the difficulty of prediabetes detection than model architecture. Multiclass prediction provides a more clinically informative representation of metabolic risk progression but highlights a trade-off between clinically meaningful stratification and predictive accuracy.