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Background <p>Cardiorenal-protective sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) lack selection guidance. We aimed to build a SGLT-2i/GLP-1RA Decision Score (TiP DecScore) to tailor selection between them.</p> Methods <p>We developed the TiP DecScore in type 2 diabetes (T2D) patients receiving either therapy from the China Metabolic Analytics Project (derivation dataset: n = 24,322; validation dataset: n = 1,459), using gradient boosting decision tree and 15 features. The primary outcomes were glycated haemoglobin (HbA<sub>1c</sub>) control (&lt;7%) and HbA<sub>1c</sub> levels at 6 and 12 months. The model’s clinical effectiveness was evaluated by comparing HbA<sub>1c</sub> control between concordant (receiving the predicted optimal therapy) and discordant groups (receiving the predicted non-optimal therapy).</p> Results <p>Here we show the derivation cohort has mean (SD) age 53.7 (11.5) years, 63.0% males. Model validation shows good predictive performance (the receiver operating characteristic curve 0.71-0.78). GLP-1RA is favored over SGLT-2i (57.6% vs. 24.2% at 6 months; 57.9% vs. 28.6% at 12 months). At 6 months, compared with SGLT-2i, GLP-1RA is prioritized for patients with a shorter diabetes duration and higher fasting C-peptide, alanine aminotransferase, body mass index (BMI), and low-density lipoprotein cholesterol levels. At 12 months, patients with higher baseline HbA<sub>1c</sub> and BMI levels are more likely to be recommended GLP-1RA than SGLT-2i. Higher rates of HbA<sub>1c</sub> control are observed in concordant versus discordant groups, especially in younger patients (&lt;55 years; 64.1% vs. 46.2%, P = 0.001) and males (58.6% vs. 45.6%, P = 0.018) at 12 months.</p> Conclusions <p>The TiP DecScore effectively guides personalized selection between SGLT-2i and GLP-1RA therapies for T2D patients.</p> <p></p>

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A machine learning model for optimizing treatment of patients with poorly controlled type 2 diabetes

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月17日

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  • Juan Shi,
  • Cong Liu,
  • Jiahang Hu,
  • Yuancheng Dai,
  • Ying Peng,
  • Fengmei Xu,
  • Haonan Shi,
  • Yunsong Li,
  • Jun Li,
  • Zunhai Zhou,
  • Chunfang Wen,
  • Shan Huang,
  • Yi Shu,
  • Xiaolin Ye,
  • Aifang Wang,
  • Hongxia Zhao,
  • Ping Feng,
  • Shengli Wu,
  • Dandan Wang,
  • Ping Liu,
  • Yi Shi,
  • Shuhui Yang,
  • Weiwei Tu,
  • Lei Chen,
  • Chaoli Yu,
  • Guang Ning,
  • Yufan Wang,
  • Zhiyun Zhao,
  • Yifei Zhang,
  • Weiqing Wang

摘要

Background

Cardiorenal-protective sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) lack selection guidance. We aimed to build a SGLT-2i/GLP-1RA Decision Score (TiP DecScore) to tailor selection between them.

Methods

We developed the TiP DecScore in type 2 diabetes (T2D) patients receiving either therapy from the China Metabolic Analytics Project (derivation dataset: n = 24,322; validation dataset: n = 1,459), using gradient boosting decision tree and 15 features. The primary outcomes were glycated haemoglobin (HbA1c) control (<7%) and HbA1c levels at 6 and 12 months. The model’s clinical effectiveness was evaluated by comparing HbA1c control between concordant (receiving the predicted optimal therapy) and discordant groups (receiving the predicted non-optimal therapy).

Results

Here we show the derivation cohort has mean (SD) age 53.7 (11.5) years, 63.0% males. Model validation shows good predictive performance (the receiver operating characteristic curve 0.71-0.78). GLP-1RA is favored over SGLT-2i (57.6% vs. 24.2% at 6 months; 57.9% vs. 28.6% at 12 months). At 6 months, compared with SGLT-2i, GLP-1RA is prioritized for patients with a shorter diabetes duration and higher fasting C-peptide, alanine aminotransferase, body mass index (BMI), and low-density lipoprotein cholesterol levels. At 12 months, patients with higher baseline HbA1c and BMI levels are more likely to be recommended GLP-1RA than SGLT-2i. Higher rates of HbA1c control are observed in concordant versus discordant groups, especially in younger patients (<55 years; 64.1% vs. 46.2%, P = 0.001) and males (58.6% vs. 45.6%, P = 0.018) at 12 months.

Conclusions

The TiP DecScore effectively guides personalized selection between SGLT-2i and GLP-1RA therapies for T2D patients.