Hybrid CNN-Fuzzy Logic System for Type 2 Diabetes Mellitus Prediction: A Clinical Decision Support Tool with Interpretability Enhancement
DOI:
https://doi.org/10.15294/edukom.v12i2.40977Keywords:
CNN, Fuzzy Logic, Machine Learning, Pima Indians, T2DMAbstract
Type 2 Diabetes Mellitus (T2DM) is a critical global health challenge, with 589 million adults currently diagnosed and projected to reach 853 million by 2050. Early detection is crucial, as it can reduce complication incidence by 30-40%, yet approximately 50% of cases remain undiagnosed. While machine learning approaches demonstrate promise for T2DM risk prediction, current systems face a fundamental accuracy-interpretability paradox: deep learning models achieve high accuracy (88-93%) but lack clinical transparency, while interpretable models sacrifice predictive performance. This study develops and validates a hybrid CNN-Fuzzy Logic system that directly addresses this paradox by combining high predictive accuracy with clinical interpretability. The system employs a Convolutional Neural Network component for non-linear feature abstraction combined with Mamdani Fuzzy Logic incorporating clinically derived weights aligned with ADA 2024 diagnostic criteria. Tested on the Pima Indian Diabetes dataset (n=154 test cases), the hybrid model achieved 92.5% accuracy (95% CI: 88.2-96.1%), 91.2% sensitivity, 93.1% specificity, and AUC-ROC 0.925, statistically superior to standalone CNN (88.9%, p=0.0037) and Fuzzy Logic (88.3%, p=0.0015) approaches. Interpretability scores reached 0.78-0.86, exceeding pure neural network baselines (0.32-0.42) and supporting clinician-understandable risk stratification. The system is operationalized as a web-based Clinical Decision Support System supporting both individual patient assessment and batch population screening. This hybrid architecture directly bridges the accuracy-interpretability paradox that has historically constrained ML adoption in clinical diabetes management.
References
Aamir, K. M., Sarfraz, L., Ramzan, M., Bilal, M., Shafi, J., & Attique, M. (2021). A fuzzy rule-based system for classification of diabetes. Sensors, 21(23). https://doi.org/10.3390/s21238095
Chang, V., Bailey, J., Xu, Q. A., & Sun, Z. (2023). Pima Indians diabetes mellitus classification based on machine learning (ML) algorithms. Neural Computing and Applications, 35(22), 16157–16173. https://doi.org/10.1007/s00521-022-07049-z
Dianna J Magliano; Edward J Boyko. (2025). IDF Diabetes Atlas. In IDF Diabetes Atlas. In International Diabetes Federation: 11th editi (11th ed.). https://www.idf.org/aboutdiabetes/type-2-diabetes.html
Iparraguirre-Villanueva, O., Espinola-Linares, K., Flores Castañeda, R. O., & Cabanillas-Carbonell, M. (2023). Application of Machine Learning Models for Early Detection and Accurate Classification of Type 2 Diabetes. Diagnostics, 13(14), 1–16. https://doi.org/10.3390/diagnostics13142383
Jayawardena, R., Sooriyaarachchi, P., & Misra, A. (2021). Abdominal obesity and metabolic syndrome in South Asians: prevention and management. Expert Review of Endocrinology and Metabolism, 16(6), 339–349. https://doi.org/10.1080/17446651.2021.1982381
Kiran, M., Xie, Y., Anjum, N., Ball, G., Pierscionek, B., & Russell, D. (2025). Machine learning and artificial intelligence in type 2 diabetes prediction: a comprehensive 33-year bibliometric and literature analysis. Frontiers in Digital Health, 7(March), 1–27. https://doi.org/10.3389/fdgth.2025.1557467
Leila Marashi Hosseini, Sima Jafarirad, A. M. H. (2023). A fuzzy based dietary clinical decision support system for patients with multiple chronic conditions (MCCs) (Vol. 13, pp. 1–8). https://doi.org/10.1038/s41598-023-39371-4
Li, W., Peng, Y., & Peng, K. (2024). Diabetes prediction model based on GA-XGBoost and stacking ensemble algorithm. PLoS ONE, 19(9 September), 1–29. https://doi.org/10.1371/journal.pone.0311222
Lin, X., Xu, Y., Pan, X., Xu, J., Ding, Y., Sun, X., Song, X., Ren, Y., & Shan, P. F. (2020). Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Scientific Reports, 10(1), 1–11. https://doi.org/10.1038/s41598-020-71908-9
Luis Fregoso Aparicio, Julieta Noguez, Luis Montesinos, J. A. G. (2021). Fregoso Aparicio_s13098-021-00767-9.pdf. 13, 1–22. https://doi.org/10.1186/s13098-021-00767-9
Naz, H., & Ahuja, S. (2020). Deep learning approach for diabetes prediction using PIMA Indian dataset. Journal of Diabetes and Metabolic Disorders, 19(1), 391–403. https://doi.org/10.1007/s40200-020-00520-5
Netayawijit, P., Chansanam, W., & Sorn-In, K. (2025). Interpretable Machine Learning Framework for Diabetes Prediction: Integrating SMOTE Balancing with SHAP Explainability for Clinical Decision Support. Healthcare (Switzerland), 13(20), 1–26. https://doi.org/10.3390/healthcare13202588
Ong, K. L., Stafford, L. K., McLaughlin, S. A., Boyko, E. J., Vollset, S. E., Smith, A. E., Dalton, B. E., Duprey, J., Cruz, J. A., Hagins, H., Lindstedt, P. A., Aali, A., Abate, Y. H., Abate, M. D., Abbasian, M., Abbasi-Kangevari, Z., Abbasi-Kangevari, M., ElHafeez, S. A., Abd-Rabu, R., … Vos, T. (2023). Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet, 402(10397), 203–234. https://doi.org/10.1016/S0140-6736(23)01301-6
Podlipskyte, A., Kazukauskiene, N., Varoneckas, G., & Mickuviene, N. (2022). Association of Insulin Resistance With Cardiovascular Risk Factors and Sleep Complaints: A 10-Year Follow-Up. Frontiers in Public Health, 10(May), 1–11. https://doi.org/10.3389/fpubh.2022.848284
Reza, M. S., Amin, R., Yasmin, R., Kulsum, W., & Ruhi, S. (2024). Improving diabetes disease patients classification using stacking ensemble method with PIMA and local healthcare data. Heliyon, 10(2), 1–13. https://doi.org/10.1016/j.heliyon.2024.e24536
Riskesdas. (2019). Laporan Riskesdas 2018 Nasional.pdf. In Lembaga Penerbit Balitbangkes (p. hal 156). Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan )LPB). https://repository.badankebijakan.kemkes.go.id/id/eprint/3514/1/Laporan Riskesdas 2018 Nasional.pdf
Rudin, C. (2019). Stop explaining black box machine learning models for high stakes decisions and use interpretable models instead. Nature Machine Intelligence, 1(5), 206–215. https://doi.org/10.1038/s42256-019-0048-x
Rudin, C., Chen, C., Chen, Z., Huang, H., Semenova, L., & Zhong, C. (2022). Interpretable machine learning: Fundamental principles and 10 grand challenges. Statistics Surveys, 16, 1–85. https://doi.org/10.1214/21-SS133
Sarvamangala, D. R., & Kulkarni, R. V. (2022). Convolutional neural networks in medical image understanding: a survey. Evolutionary Intelligence, 15(1), 1–22. https://doi.org/10.1007/s12065-020-00540-3



