CHAPTER ONE

1.1. Background
Diabetes mellitus is the commonest endocrine-metabolic disorder characterized by
chronic hyperglycaemia giving rise to the risk of microvascular (retinopathy,
nephropathy, and neuropathy) and macrovascular (ischaemic heart disease, stroke and
peripheral vascular disease) damage, with associated reduced life expectancy and
diminished quality of life. Diabetes mellitus may present with characteristic symptoms
such as thirst, polyuria, blurring of vision, and weight loss. In its most severe forms,
ketoacidosis or a nonketotic hyperosmolar state may develop and lead to stupor, coma
and, in absence of effective treatment, death (WHO, 1999). People with diabetes are at
increased risk of cardiovascular, peripheral vascular and cerebrovascular disease.
Several pathogenetic processes are involved in the development of diabetes. These
include processes, which destroy the beta cells of the pancreas with consequent insulin
deficiency, and others that result in resistance to insulin action. The abnormalities of
carbohydrate, fat and protein metabolism are due to deficient action of insulin on target
tissues resulting from insensitivity or lack of insulin (WHO, 1999). The prevalence of
diabetes is increasing rapidly worldwide and the World Health Organization (2003) has
predicted that by 2030 the number of adults with diabetes would have almost doubled
worldwide, from 177 million in 2000 to 370 million. Experts project that the incidence
of diabetes is set to soar by 64% by 2025 meaning that the disease will affect a
staggering 53.1 million citizens (Rowley and Bezold, 2012). The estimated worldwide
prevalence of diabetes among adults in 2010 was 285 million (6.4%) and this value is
predicted to rise to around 439 million (7.7%) by 2030 (Shaw et al., 2010). Recent
estimates indicate there were 171 million people in the world with diabetes in the year
2000 and this is projected to increase to 366 million by 2030. This increase in

prevalence is expected to be more in the Middle Eastern crescent, Sub-Saharan Africa

and India. In Africa, the estimated prevalence of diabetes is 1% in rural areas, up to 7%
in urban sub-Sahara Africa, and between 8-13% in more developed areas such as South
Africa and in population of Indian origin Africa (Sonny C. et al., 2011).

The

prevalence in Nigeria varies from 0.65% in rural Mangu (North) to 11% in urban Lagos
(South) and data from the World Health Organization (WHO) suggests that Nigeria has
the greatest number of people living with diabetes in Africa (Wild S et al., 2004). It is
pertinent to note that in our setting, clinical criteria are often used to classify patients
with DM into Type 1 and Type 2 Diabetes Mellitus (T2DM). These criteria include a
cut off age of thirty years and insulin requirements or usage since diagnosis. For T2DM
additional clinical criteria for diagnosis, include history of usage of oral hypoglycaemic
agents or usage of combination of insulin and the oral hypoglycaemic agents (Ogbera et
al., 2014).
Type 2 Diabetes Mellitus (T2DM) risk factors allow for a prediction of an individuals
predisposition to developing T2DM disease. The presence of multiple risk factors
increases an individuals chance of being affected by T2DM in an exponential and not
additive manner (Blessey, 1985). Risk factors could be modifiable or non-modifiable.
Non-modifiable risk factors include age, sex, race and a positive family history.
Modifiable risk factors include smoking, excess alcohol use, unhealthy diet, obesity,
hyperlipidaemia, sedentary or physical inactivity (Ellis, 1948; Dawber and Kannel,
1958; Blessey, 1985; Rosengren et al, 2004; Yusuf et al, 2004; Stein et al, 2005; Anad et
al, 2008; Mayosi et al., 2009). Type 2 diabetes is due primarily to lifestyle factors and
genetics. A number of lifestyle factors are known to be important to the development of
type 2 diabetes, including obesity (defined by a body mass index of greater than thirty),
lack of physical activity, poor diet, stress, sedentary, and urbanization. Dietary factors

also influence the risk of developing type 2 diabetes. Consumption of sugar-sweetened

drinks in excess is associated with an increased risk (Malik VS et al., 2010). The type
of fats in the diet is also important, with saturated fats and trans fatty increasing the
risk and polyunsaturated and monounsaturated fat decreasing the risk. Eating lots of
white rice appears to also play a role in increasing risk (Hu EA et al., 2012).
The Diabetes is diseases that has significant burden on and healthcare systems.
Nowadays, there are many researches in the field of diabetes monitoring. Some of these
evolutions in diabetes monitoring were the use computer systems. In 2004, H. kwon et
al. designed new diabetes monitoring system model online using the internet. By using
this system patients can contact physicians online, to provide them with information
and receive recommendations. Another system that was developed by A. Kollmann et
al. in 2007 find that mobile phone can be used to provide a ubiquitous, easy-to-use, and
cost efficient solution for management of diabetes mellitus type1 (T1DM). They did a
feasibility study to see how much mobile phone-based data service could be accepted
with diabetes mellitus type1 patients, and how much the services can assist T1DM
patient on intensive insulin treatment. For this study, researchers had developed
software called Diab-memory to support patients entering their information such as
blood-glucose level, injected insulin doses, food intake, well-being and physical
activities. Then, data were remotely synchronized to a central database. The system was
based on Java2 Mobile edition (J2ME) and built using state of the art internet
technology.
The study sample was 10 patients with T1DM. Mean age was 36.6 years (11.0 years)
being in the trail study for three months. The result was focused on patients' adherence
to the therapy, availability of the monitoring system and the effects on metabolic status.

As questionnaire shows, the system was accepted in general, and this shows that the
role of information system in the health sector cannot be overlooked.
Towards reducing the burden of DM (majorly T2DM) in Nigeria, there is need for
concerted efforts by healthcare professionals and stakeholders in the health industry to
put in place preventative measures, a better functioning health insurance scheme and a
structured T2DM program. Therefore, earlier detection, public awareness and peoples
education seem to be the way out as human behaviour may slow down progress in the
eradication of diseases. People are eating less fruits and vegetables, more sugar, salt and
saturated fat. This together with decreases level of physical activity and other unhealthy
habits has resulted in more cases of T2DM and other diseases such as Diabetes mellitus
disorder (Humink et al., 1997). Due to scarce resources and inadequate health
provision, given the difficulty of long-term drug treatment in low-income countries,
primary prevention assumes a greater public health importance (Adedoyin et al., 2008).
This is motivated by the need for the provision of a decision support system, which
helps medical experts easily monitor Diabetes Mellitus (DM) diseases risk among
patients with a view of early detection of the likely occurrence.
1.2 Statement of the Problem
There is compelling data to show an increasing incidence and prevalence of DM in the
continent. The estimated prevalence of diabetes in Africa is 1% in rural areas, and
ranges from 5% to 7% in urban sub-Saharan Africa (Ogbera et al, 2014). Healthcare
providers require an accurate estimate of the Diabetes mellitus risk in patients to plan
the best possible allocation of finite resources to the core elements of DM control:
primary prevention, screening and early diagnosis, treatment, rehabilitation and
palliative care. Diabetes mellitus diseases affect individuals in their peak, early and
mid-life years disrupting the future of the families dependent on them and undermining

the development of the nations by depriving them of valuable human resources in their
most productive years (WHO, 2002). This is because Diabetes mellitus diseases could
eventually lead to disabilities such as stroke and thus, scarce family and societal
resources are directed to the costly and prolonged medical care of such ones (WHO,
2002). Therefore, the challenge of this project is to understand the risk factors or
variables that are responsible for the likelihood of Type 2 Diabetes Mellitus (T2DM)
disease occurrence and evaluate the likelihood of T2DM disease based on these
variables.
1.3 Scope of the Problem
This project is limited in scope by the development of a predictive model for Type 2
Diabetes Mellitus risk using Fuzzy Logic model.
1.4 Aim and Objectives of the study
The aim of this study is to develop a model for prediction of T2DM disease using the
Fuzzy Logic Model.
The specific objective of this study is to:
(i)
identify variables required for predicting T2DM disease risk.
(ii)
simulate the model.
(iii)
validate the model
1.5 Methodology
In order to achieve the aforementioned objectives, the methodology approach will be as
follows:
(i)

Extensive review of related work on diabetes mellitus prediction will be

done followed by formal interview with disease expert (Endocrinologists) to

(ii)

elicit knowledge on variables relevant for disease risk identification.

The fuzzy logic will be used to develop the predictive model for type 2

(iii)

diabetes mellitus disease risk using the variables identified in (i).

Simulate the Type 2 Diabetes Mellitus diseases risk predicting system using
the model in (ii).

(iv)

The performance of the model will be evaluated using performance metrics

like: accuracy, sensitivity, precision and recall (1-specificity).

1.6 Justification of the Study

This study is necessitated by the need to prevent calamitous outbreak of diseases that
may send many to untimely grave with the aim of an early detection system (WHO,
2002), is pitched towards prevention, and planned response to this terminal disease. To
gain a better knowledge of disease incidence and risk factors so as to control them; with
the aim of improving the health care delivery in Nigeria.
Nigerian health status indicators are very poor with slow improvement in key health
indicators, today Nigeria ranks among countries with increasing Diabetes mellitus
diseases occurrences. The outcome of this study will assist people to be able to know if
they are likely to have Type 2 Diabetes mellitus disease and serve as decision support
system for users. Thus, adequate provision of medical services can be made to address
these occurrences. Health planning is the art of projecting health service developments
in the future by specifying the kinds and amounts of resources, as well as the ways they
will be mobilized and distributed
1.7 Thesis Arrangement
This project work is made up of five chapters, each chapter dealing with specific area of
the project. Chapter one gives information about the background of the study, statement
of problem, objectives, methodology, scope, and thesis arrangement. Chapter two
presents the general nature of Diabetes mellitus diseases, its global effects, causes risk
factors, review of relevant literatures and related works, and prediction in health care
and different prediction systems in the medical sciences. Chapter three gives details
about the methodology of the project work; the variables needed, data collection
process, Schematic representation of the proposed system, fuzzification of the input

variables and aggregation of the output variables, the software used for the
implementation of the system. Chapter four gives detailed information about the system
design, implementation and the tools used in the development of the system. It also
gives a description of the user interface, which the user uses in interacting with the
system. Finally, chapter five concludes the work by stating the summary, conclusion
and recommendation of the work done.

CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction
According to Detmer (1997), epidemiology is the study of the distribution and
patterns of health-events, health-characteristics and their causes or influences in welldefined populations. It is the cornerstone method of public health research and
practice, and helps inform policy decisions and evidence-based medicine by
identifying risk factors for diseases and targets for preventive medicine and public
policies. Epidemiologists are involved in the design of studies, collection and
statistical analysis of data, and interpretation and dissemination of results (including
peer review and occasional systematic review). Over the past 30 years, epidemiology
has significantly contributed to improve methods used in clinical research and, to a
lesser extent, basic (microbiological, genetic) research (Jankowski, 1999). Major
areas of epidemiological study include bio monitoring, and comparisons of treatment
effects such as in clinical trials, outbreak investigation, diseases surveillance and
screening (medicine). Epidemiologists rely on a number of other scientific disciplines
such as Biology (to better understand diseases processes), Biostatistics (to make
efficient use of the data and draw appropriate conclusions), and Exposure assessment
and Social science disciplines (to better understand proximate and distal risk factors,
and their measurement (Bourlas et al, 1999).
The advancement in computer technology has encouraged the researchers to develop
software for assisting doctors in making decision without consulting the specialists
directly. The software development exploits the potential of human intelligence such
as reasoning, making decision, learning (by experiencing) and many others. Artificial
intelligence is not a new concept, yet it has been accepted as a new technology in

computer science. It has been applied in many areas such as education, business,
medical and manufacturing. This project explores the potential of artificial
intelligence techniques in determining the likelihood of Diabetes mellitus diseases in
an individual given a number of associated risk factors.
2.2 Diabetes Mellitus Diseases
Type 2 diabetes mellitus (T2DM) is the commonest form of diabetes affecting more
than 90% of the diabetic population worldwide. There is a rapid upsurge in the
number of diabetic patients and this explosive growth is noted in both urban and rural
areas. Wild et al. estimated the number of T2DM patients in the year 2000 at 174
million and predicted it to increase to 366 million in 2030. Diabetes mellitus (DM) is
a serious condition with potentially devastating complications that affects all age
groups worldwide. In 1985, an estimated 30 million people around the world were
diagnosed with diabetes; in 2000, that figure rose to over 150 million; and, in 2012,
the International Diabetes Federation (IDF) estimated that 371 million people had
diabetes. That number is projected to rise to 552 million (or 1 in 10 adults) by 2030,
which equates to three new cases per second (Sonny C. et al., 2011). This increase in
prevalence is expected to be more in the Middle Eastern crescent, Sub-Saharan Africa
and India. In Africa, the estimated prevalence of diabetes is 1% in rural areas, up to
7% in urban sub-Sahara Africa, and between 8-13% in more developed areas such as
South Africa and in population of Indian origin. The prevalence in Nigeria varies from
0.65% in rural Mangu (North) to 11% in urban Lagos (South) and data from the
World Health Organization (WHO) suggests that Nigeria has the greatest number of
people living with diabetes in Africa (Sonny C. et al., 2011).

10

2.2.1

Epidemiology of Type 2 Diabetes Mellitus Diseases

Mortality rates generally appear to be most closely linked to a countrys stage of

epidemiological transition. Epidemiological transition, a concept first proposed by
Abdel Omran in the 1970s (Omran, 1971), refers to the changes in the predominant
forms of diseases and mortality burdening a population that occur as its economy and
health systems develops. In underdeveloped countries at the early stages of
epidemiological transition, infectious diseases predominate, but as the economy,
development status, and health systems of these countries improve, the population
moves to a later stage of epidemiological transition, and chronic non-communicable
diseases become the predominant causes of death and diseases (Gaziano et al, 2006).
Recent estimates indicate there were 171 million people in the world with diabetes in
the year 2000 and this is projected to increase to 366 million by 2030. Diabetes is a
condition primarily defined by the level of hyperglycaemia giving rise to risk of
microvascular damage (retinopathy, nephropathy and neuropathy). It is associated
with reduced life expectancy, significant morbidity due to specific diabetes related
microvascular complications, increased risk of microvascular complications
(ischaemic heart disease, stroke and peripheral vascular disease), and diminished
quality of life. The American Diabetes Association (ADA) estimated the national
costs of diabetes in the USA for 2002 to be $us132 billion, increasing to $us192
billion in 2020 (WHO, 2006).
2.2.2

Aetiology Of Diabetes Mellitus: Non-Insulin Dependency Diabetes

Mellitus (NIDDM)

Non-Insulin Dependency Diabetes Mellitus (NIDDM) is also known as Type 2

diabetes mellitus, which is the predominant form of diabetes and accounts for at least
90% of all cases of diabetes mellitus (Gonzalez et al., 2009). The rise in prevalence

11

is predicted to be much greater in developing than in developed countries (69

versus 20%) (Shaw. et al., 2010).
In developing countries, people aged 40 to 60 years (that is, working age) are affected
most, compared with those older than 60 years in developed countries (Shaw et al.,
2010). This increase in type 2 diabetes is inextricably linked to changes towards a
Western lifestyle (high diet with reduced physical activity) in developing countries
and the rise in prevalence of overweight and obesity (Chan et al., 2009; Colagiuri,
2010). There are approximately 1.4 million people with diagnosed type 2 diabetes in
the UK (Bennett et al., 1995). The incidence of diabetes increases with age, with most
cases being diagnosed after the age of 40 years. This equates to a lifetime risk of
developing diabetes of 1 in 10 (Neil et al., 1987). Type 2 diabetes is a heterogeneous
disorder caused by a combination of genetic factors related to impaired insulin
secretion, insulin resistance and environmental factors such as obesity, over eating,
lack of exercise, and stress as well as aging (Kaku, 2010). It is typically a
multifactorial disease involving multiple genes and environmental factors to varying
extents (Holt, 2004). Type 2 diabetes is the common form of idiopathic diabetes and is
characterized by a lack of the need for insulin to prevent ketoacidosis. It is not an
autoimmune disorder and the susceptible genes that predispose to NIDDM have not
been identified in most patients. This could be due to the heterogeneity of the genes
responsible for the susceptibility to NIDDM
2.3 Type 2 Diabetes Mellitus Diseases Risk Factors
Risk factors can be either modifiable or non-modifiable. Modifiable risk factors
include; smoking, obesity, sedentary lifestyle, and lipid disorders. Non-modifiable
risk factors include; age, sex, and family history (Danaei et al, 2006).

12

The effects of risk factors is multiplicative rather than additive, thus people with a
combination of risk factors (for example, smoking, obesity and hypertension) have the
greatest risk of developing heart diseases. It is important to distinguish between
relative risk (the proportional increase in risk) and absolute risk (the actual chance of
an event). Thus, a 35 year old man with a plasma cholesterol of 10mmol/litre who
smokes 40 cigarettes a day is relatively much more likely to die from coronary
diseases within the next decade than a non-smoking woman of the same age with a
normal cholesterol, but the absolute likelihood of his dying during this time is still
small (high relative risk, low absolute risk) (Blessey, 1985).
Proximal risks for T2DM include those associated with consumption patterns (mainly
linked to diets, tobacco and alcohol use), activity patterns, and health service use as
well as biological risk factors such as increased cholesterol, blood pressure, blood
glucose, and clinical diseases. The Framingham Study first centred attention on the
concept of risk factors associated with T2DM, and most recently reported
substantial 30-years risk data showing the accumulation of risk over time (Pencina et
al, 2009). Importantly, risk factors for the incidence of T2DM and those associated
with T2DM severity or mortality are not synonymous. Risk factors for incidence
become important starting very early in life and accumulate with behavioural, social,
and economic factors over the life course to culminate in biological risks for T2DM
such as increased blood pressure, blood glucose, and clinical diseases. Over the past
few decades, the effectiveness of early screening and long-term treatment for
biological risks or early diseases has contributed to the sharp declines in DM
mortality seen in many countries (Humink et al, 1997). The American Diabetes
Association Guide to Diabetes Medical Nutrition Therapy and Education (Ross,
Boucher, and O'Connell, 2005) listed the major risk factors for type 2 diabetes

13

mellitus as: age 45 years, ethnicity, family history, habitual physical inactivity,
overweight (BMI 25 kg/m2), hypertension ( I40/90 mm Hg in adults), and
previously diagnosed impaired fasting glucose or impaired glucose tolerance, HDL
cholesterol < 35mg/dl) and/or triglyceride level (>250 mg/dl), polycystic ovary
syndrome, and history of vascular disease.
The recent WHO Global Health Risks Report of 2009 (Lopez et al, 2006) and the
earlier World Health Report of 2002 provide comparable and robust estimates of the
contribution of risks to total mortality and measures of disability (Mathers et al, 2003;
WHO, 2002, 2009b). Relatively few major behavioural and biological risk factors
account for T2DM incidence around the world. Tobacco use, diet (including alcohol,
total calorie intake, and specific nutrients) and physical inactivity serve as the three
major behavioural risks. Between them, they account for a significant proportion of
cancer, cardiovascular disease, and chronic respiratory diseases incidence in addition
to DM (Hu et al, 2001; WHO, 2002; Yach et al, 2004, 2005; Van Dam et al, 2008).
Concerted action focused on these behavioural risks, along with biological risks such
as high blood pressure, high blood lipids, and high blood glucose, would have a wide
impact on the global incidence and burden of diseases (WHO, 2009b). High blood
pressure, tobacco use, elevated blood glucose, physical inactivity, and overweight and
obesity are the five leading factors globally. In middle income countries, alcohol
replaces high blood glucose in the top five; in low income countries, a lack of safe
water, unsafe sex, and under nutrition are important. These latter points are related
to both the role of early childhood nutrition in the later onset of cardiovascular disease
and DM as well as the need to integrate the management of HIV/AIDS more closely
with DM in low-income countries (WHO, 2009b).

14

2.3.1

Body Mass Index: Overweight and Obesity

Overweight and obesity are defined as abnormal or excessive fat accumulation that
presents a risk to health. A crude population measure of obesity is the body mass
index (BMI), a persons weight (in kilograms) divided by the square of his or her
height (in metres). A person with a BMI of 30 or more is generally considered obese.
A person with a BMI equal to or more than 25 is considered overweight (WHO,
2015). Overweight and obesity are major risk factors for a number of chronic
diseases, including diabetes, cardiovascular diseases and cancer. Once considered a
problem only in high-income countries, overweight and obesity are now dramatically
on the rise in low- and middle-income countries, particularly in urban settings (WHO,
2015). According to Lebovitz (2004), overweight and obesity is a risk factor for
developing type 2 diabetes. The best measure of overweight and obesity is the body
mass index (BMI). Overweight status, a BMI of equal to or greater than 25 kg/m2,
and obesity, a BMI greater than or equal to 30 kg/m2, have become a problem
throughout the World. BMI levels of this proportion cause an increased risk of
developing many types of chronic diseases, including type 2 diabetes mellitus. In fact,
the term "diabesity" has been used to demonstrate the close link between type 2
diabetes mellitus and obesity.
2.3.2

Smoking

Nakanishi, Nakamura, Matsuo, Suzuki and Tatara (2000) have linked smoking to
diabetes. In this 5-year study of 1266 male Japanese office workers, 87 developed
impaired fasting glucose and 54 men developed type 2 diabetes mellitus. They found
that the number of cigarettes smoked per day as well as exposure to second hand
smoke was associated with development of the disease in these men. Therefore,

15

Wannamethee, Shaper, and Perry (2001) concluded that smoking is considered a risk
factor for developing type 2 diabetes mellitus.
2.3.3

Age

Age is an important risk factor in developing cardiovascular and diabetes mellitus

diseases, it is estimated that 87 percent of people who die of coronary heart diseases
are 60 and older (American Heart Association, 2001). In the age group of 20-44 years,
it was estimated about 3.7% people had diabetes mostly the type 2 diabetes mellitus;
while in the age group 45-64 years the number increased to 13.7%; and the highest
percentage of 26.9% was found in the age group of 65 years (Centres for Disease
Control and Prevention, 2011). Similar feature was also observed in England, where
the prevalence of diabetes was increasing with age. The peak prevalence of type 2
diabetes can be found in the age group of 65-74 years with 15.7% in men and 10.4%
in women (Shelton, 2006). T2DM becomes increasingly common with advancing age
As a person gets older; the body undergoes subtle physiologic changes, even in the
absence of diseases (WHO, 2008b).
2.3.4

Physical Activity

WHO and FAO highlighted the importance of physical activity as a key determinant
of obesity, CVD, and diabetes (Joint WHO/FAO Expert Consultation, 2003).
Physical activity is defined as any bodily movement produced by skeletal muscles that
require energy expenditure. It has been identified as the fourth leading risk factor for
global mortality causing an estimated 3.2 million deaths globally. Physical activity is
a key determinant of energy expenditure, and thus is fundamental to energy
balance and weight control, Physical activity reduces risk for cardiovascular
diseases and diabetes and has substantial benefits for many conditions, not only

16

those associated with obesity. The beneficial effects of physical activity on the
metabolic syndrome are mediated by mechanisms beyond controlling excess body
weight. For example, physical activity reduces blood pressure, improves the level of
high-density lipoprotein cholesterol, improves control of blood glucose in overweight
people, even without significant weight loss, and reduces the risk for colon cancer and
breast cancer among women (WHO, 2004).
2.3.5

Urban-Rural Differences

Residence seems to be a major determinant of type 2 diabetes in Sub-Saharan Africa.

Since urban residents have 1.5- to 4.0 times higher prevalence of type 2 diabetes than
their rural counterparts. This is attributable to lifestyle changes associated with
urbanization and Westernization. Urban lifestyle in Africa is characterized by changes
in dietary habits involving an increase in the consumption of refined sugars and
saturated tut and a reduction in liber intake (Mennen et al. 2000). Sohngwi and
colleagues (2002) have recently reported an increase in fasting plasma glucose in
those whose lives have been spent in an urban environment, suggesting that both
lifetime exposure to and recent migration to or current residence in an urban
environment are potential risk factors for obesity and type 2 diabetes mellitus. The
disease might represent the cumulative effects over years of dietary changes, decrease
in physical activity, and psychological stress.
The population of Africa is predominantly rural, but the 19952000 urban growth
rate was estimated at 4.3 percent (compared with 0.5 percent in Europe). Thus, more
than 70 percent of the population of Africa will he urban residents by 2025 (UNFPA
2000). There will therefore be a tremendous increase in the prevalence of type 2
diabetes attributable to rapid urbanization.

17

2.3.6

Gender

In the first half of the last century, the prevalence of type 2 diabetes was higher among
women than among men, but this trend has shifted, so more men than women are now
diagnosed with type 2 diabetes. This change in the gender distribution of type 2
diabetes is mainly caused by a more sedentary lifestyle particularly among men,
resulting in increased obesity. However, recent data have also shown that men develop
type 2 diabetes at a lower degree of obesity than women a finding that adds support
to the view that the pathogenesis of type 2 diabetes differs between men and women.
Observations of sex differences in body fat distribution, insulin resistance, sex
hormones, and blood glucose levels further support this notion (Frch, K., 2014). The
body fat distribution, especially the abdominal visceral fat is associated with increased
type 2 diabetes risk. Body fat distribution differs by sex (Logue J. et al., 2011), and in
general men have more abdominal fat, whereas women have more peripheral fat
also denoted as apple versus pear shape. Looking into the abdominal fat, men
also tend to have more visceral and hepatic fat than women do, whereas women have
more subcutaneous fat than men do. In contrast to visceral fat, subcutaneous fat is
associated with improved insulin sensitivity and is therefore protective against type 2
diabetes. Thus, the phenomenon that men develop diabetes at a lower body mass
index than women can be explained by the fact that men have more visceral fat for a
given body mass index than women and thereby a higher relative risk for developing
type 2 diabetes (Logue J. et al., 2011).
2.3.7

Family History of Diabetes

There is also ample evidence that type 2 diabetes has a strong genetic basis. The
concordance of type 2 diabetes in monozygotic twins is ~70% compared with 20
30% in dizygotic twins (Valeriya L. et al., 2013). The lifetime risk of developing the

18

disease is ~40% in offspring of one parent with type 2 diabetes, greater if the mother
is affected and approaching 70% if both parents have type 2 diabetes. In prospective
studies, we have demonstrated that first-degree family history is associated with
twofold increased risk of future type 2 diabetes (Valeriya L. et al., 2013). The
challenge has been to find genetic markers that explain the excess risk associated with
family history of type 2 diabetes. A significant proportion of the offspring of
Cameroonians with type 2 diabetes have either type 2 diabetes (4 percent) or IGT (8
percent) (Mhanya et al. 2000). A positive family history seems to be an independent
risk factor for type 2 diabetes, but this was not the case in the Cape Town study
(Levitt et al, 1993), in which family history has not an independent risk factor.
2.3.8

Prediabetes

In 1997 and 2003, the Expert Committee on Diagnosis and Classification of Diabetes
Mellitus (Expert Committee on the Diagnosis and Classification of Diabetes Mellitus,
1997, Genuth S, et al., 2003) recognized an intermediate group of individuals whose
glucose levels do not meet criteria for diabetes, yet are higher than those considered
normal. These people were defined as having impaired fasting glucose (IFG) [fasting
plasma glucose (FPG) levels 100 mg/dl (5.6 mmol/l) to 125 mg/dl (6.9 mmol/l)], or
impaired glucose tolerance (IGT) [2-h values in the oral glucose tolerance test
(OGTT) of 140 mg/dl (7.8 mmol/l) to 199 mg/dl (11.0 mmol/l)]. Individuals with IFG
and/or IGT have been referred to as having prediabetes, indicating the relatively high
risk for the future development of type 2 diabetes. IFG and IGT should not be viewed
as clinical entities in their own right but rather risk factors for type 2 diabetes as well
as cardiovascular disease (ADA, 2014).

19

2.4 Diagnosis of Type 2 Diabetes Mellitus Diseases

If a diagnosis of diabetes is made, the clinician must feel confident that the diagnosis
is fully established since the consequences for the individual are considerable and
lifelong. The requirements for diagnostic confirmation for a person presenting with
severe symptoms and gross hyperglycaemia differ from those for the asymptomatic
person with blood glucose values found to be just above the diagnostic cutoff value.
Severe hyperglycaemia detected under conditions of acute infective, traumatic,
circulatory or other stress may be transitory and should not in itself be regarded as
diagnostic of diabetes. The diagnosis of type 2 diabetes in an asymptomatic subject
should never be made based on a single abnormal blood glucose value. For the
asymptomatic person, at least one additional plasma/blood glucose test result with a
value in the diabetic range is essential, either fasting, from a random (casual) sample,
or from the oral glucose tolerance test (OGTT). If such samples fail to confirm the
diagnosis of diabetes mellitus, it will usually be advisable to maintain surveillance
with periodic retesting until the diagnostic situation becomes clear. In these
circumstances, the clinician should take into consideration such additional factors as
ethnicity, family history, age, adiposity, and concomitant disorders, before deciding on
a diagnostic or therapeutic course of action. An alternative to blood glucose
estimation or the OGTT has long been sought to simplify the diagnosis of diabetes.
Glycated haemoglobin, reflecting average glycaemia over a period of weeks, was
thought to provide such a test. Although in certain cases it gives equal or almost equal
sensitivity and specificity to glucose measurement (McCance D. R., 1994), it is not
available in many parts of the world and is not well enough standardized for its use to
be recommended at this time.

20

2.4.1

Specific Tests for Type 2 Diabetes Mellitus System

Testing enables health care providers to find and treat diabetes before complications
occur and to find and treat prediabetes, which can delay or prevent type 2 diabetes
from developing. Although not all tests are recommended for diagnosing all types of
diabetes, but the any one of the following tests can be used for diagnosis:

A1C Test, also called the haemoglobin A1c, HbA1c, or glycol haemoglobin

test
Fasting Plasma Glucose (FPG) Test
Oral Glucose Tolerance Test (OGTT)
Random Plasma Glucose (RPG) Test
2.4.1.1 A1C Test
The A1C test is used to detect type 2 diabetes and prediabetes but is not recommended
for diagnosis of type 1 diabetes or gestational diabetes. The A1C test is a blood test
that reflects the average of a persons blood glucose levels over the past 3 months and
does not show daily fluctuations. The A1C test is more convenient for patients than
the traditional glucose tests because it does not require fasting and can be performed
at any time of the day. The A1C test result is reported as a percentage. The higher the
percentage, the higher a persons blood glucose levels have been. A normal A1C
level is below 5.7%, and A1C of 5.7 to 6.4 %, indicates prediabetes.

People

diagnosed with prediabetes may be retested in 1 year. People with an A1C below 5.7
percent may still be at risk for diabetes, depending on the presence of other
characteristics that put them at risk, also known as risk factors. People with an A1C
above 6.0%, should be considered at very high risk of developing diabetes. A level of
6.5 percent or above means a person has diabetes (NDIC, 2014).

2.4.1.2 Fasting Plasma Glucose Test

21

The Fasting Plasma Glucose (FPG) test is used to detect type 2 diabetes and
prediabetes. The FPG test has been the most common test used for diagnosing
diabetes because it is more convenient than the OGTT and less expensive (NDIC,
2014). The FPG test measures blood glucose in a person who has fasted for at least 8
hours and is most reliable when given in the morning. People with a fasting glucose
level of 100 to 125 mg/dl have impaired fasting glucose (IFG), or prediabetes. A level
of 126 mg/dl or above, confirmed by repeating the test on another day, means a
person has diabetes.
2.4.1.3 Oral Glucose Tolerance Test
According to National Diabetes Information Clearinghouse (NDIC, 2014), OGTT can
be used to diagnose type 2 diabetes, prediabetes, and gestational diabetes. Research
has shown that the OGTT is more sensitive than the FPG test, but it is less convenient
to administer. When used to test for type 2 diabetes or prediabetes, the OGTT
measures blood glucose after a person fasts for at least 8 hours and 2 hours after the
person drinks a liquid containing 75 grams of glucose dissolved in water. If the 2-hour
blood glucose level is between 140 and 199 mg/dl, the person has a type of
prediabetes called impaired glucose tolerance (IGT). If confirmed by a second test, a
2-hour glucose level of 200 mg/dl or above means a person has diabetes.
2.4.1.4 Random Plasma Glucose (RPG) Test
The random plasma glucose (RPG) test is sometimes used to diagnose type 2 diabetes
during a regular health check-up. If the RPG measures 200 micrograms per decilitre
or above and the individual shows symptoms of diabetes, then a health care provider
may diagnose diabetes (NDIC, 2014).
2.4.2

Symptoms of Diabetes Mellitus

22

The most common signs and symptoms of diabetes are:

Frequent urination

Disproportionate thirst

Intense hunger

Weight gain

Unusual weight loss

Increased fatigue

Irritability

Blurred vision

Cuts and bruises don't heal properly or quickly

More skin and/or yeast infections

Itchy skin

Gums are red and/or swollen

Frequent gum disease/infection

Sexual dysfunction (men)

Numbness or tingling, especially in your feet and hands

2.5 Diabetes Mellitus Disease and Artificial Intelligence

In the last two decades, the use of artificial intelligence tools has become widely
accepted in medical applications to support patient diagnosis more effectively.
Especially, the application of various machine learning approaches such as decision
trees (DTs), artificial neural networks (ANNs), Bayesian networks (BNs), and support
vector machines (SVMs) have been actively tried for meeting clinical support
requirements. Consequently, CDSS or medical diagnosis systems using different
machine learning approaches have shown great potential, and many machine learning
methods have been tried for a wide variety of clinical and medical applications.
The use of decision trees is one of the most popularly applied methods for CDSS due
to its simplicity and capacity for humanly understandable inductive rules. Many

23

researchers have employed DT to resolve various biological problems, including

diagnostic error analysis (Murphy, 2001), potential biomarker finding (Qu et al, 2002;
Won et al, 2003), and proteomic mass spectra classification (Geurts et al, 2005).
Bayesian networks are a probability-based inference model, increasingly used in the
medical domain as a method of knowledge representation for reasoning under
uncertainty for a wide range of applications, including diseases diagnosis (Balla et al,
1985), genetic counselling (Harris, 1990), expert system development (Stockwell,
1993), gene network modelling (Liu et al, 2006), and emergency medical decision
support system (MDSS) design (Sadeghi et al, 2006).
Neural networks have also been applied to the medical and diagnosis fields, most
actively as the basis of a soft computing method to render the complex and fuzzy
cognitive process of diagnosis. Many applications, for example, have shown the
suitability of neural networks in CDSS design and other biomedical application,
including diagnosis of myocardial infarction (Baxt, 1990, 1995), differentiation of
assorted pathological data (Dybowski & Gant, 1995), MDSS for leukaemia
management (Chae, et al, 1998) and surgical decision support (Li et al, 2000), MDSS
for cancer detection (West & West, 2000), assessment of chest-pain patients (Ellenius
& Groth, 2000), decision making for birth mode (MacDowell et al, 2001), heart
diseases diagnosis (Turkoglu, et al, 2002), CDSS for pharmaceutical applications
(Mendyk & Jachowicz, 2005), CDSS development for gynecological diagnosis
(Mangalampalli, et al, 2006), and biological signal classification (Guven & Kara,
2006). Recently, multilayer perceptions (MLP), one of the most popular ANN models,
has been applied to build an MDSS for five different heart diseases diagnoses (Yan et

24

al., 2006). The three-layered MLP with 40 categorical input variables and modified
learning method achieved a diagnosis accuracy of over 90%.
Support vector machines are a new and promising classification and regression
technique proposed by Vapnik and his co-workers (Cortes & Vapnik, 1995; Vapnik,
1995). SVMs, developed in statistical learning theory, are recently of increasing
interest to biomedical researchers. They are not only theoretically well-founded, but
are also superior in practical applications. For medical, clinical decision support and
biological domains, SVMs have been successfully applied to a wide variety of
application domains, including MDSS for the diagnosis of tuberculosis infection
(Veropoulos, et al, 1999), tumour classification (Schubert, et al, 2003), myocardial
infarction detection (Conforti & Guido, 2005), biomarker discovery (Prados et al,
2004), and cancer diagnosis (Majumder, et al, 2005).
To overcome the limited generalization performance of single models and simple
model combination approaches, more precise model combination methods, called
ensemble methods, have been suggested. This multiple classifier combination is a
technique that combines the decisions of different classifiers that are trained to solve
the same problem but make different errors. Ensembles can reduce the variance of
estimation errors and improve the overall classification accuracy. Many ensemblebased approaches have been proposed in recent research, including an ANN ensemble
for decision support system (Ohlsson, 2004), an ensemble of ANNs for breast cancer
and liver disorders prediction (Yang & Browne, 2004), MDSS with an ensemble of
several different classifiers for breast diagnosis (West, et al, 2005), and multiple
classifier combinations with an evolutionary approach (Kim, et al, 2006).
2.5.1

Predicting Type 2 Diabetes Mellitus Disease

25

Diabetes is known as one of the most common diseases that has significant
burden on patients and healthcare systems. Nowadays, there are many researches in
the field of diabetes monitoring. These researches are coming as a sequence of
evolutions. Mashael S. B. (2013) emphasized that the first evolution in diabetes
monitoring was the use the computers to manage patient data and save their
records which include personal information, treatment progress and historical
information. Then, these monitoring systems were developed and become as dual
sides systems. In this type of systems, diabetes can be controlled remotely by
which called tele-monitoring and tele-medication. In such systems, the health care
providers offer tele-support and monitoring services to patients through a desktop
computer at home. Patient also can enter data about his daily intake food, activities,
and medication and get a right advice about his condition. Dorsey and Mayer (1994
and 1995) stated also that genetic algorithm is a useful search procedure that searches
from one population of points to another; thus directing the search to the best solution
so far rendering it as a global solution to non-linear functions.
2.5.2

Predictive models

Predictive modelling is concerned with analysing patterns and trends in historical and
operational data in order to transform data into actionable decisions. This is
accomplished by analysing and modelling the dynamics of the application-specific
data. In its raw form, this data is of limited value and is mainly used for reporting
what has happened. However, when the data is compiled into a compact model, it is a
powerful tool for proactively predicting what will happen.
In the abstract, a predictive model is a computational structure that can accurately
forecast an outcome of interest (i.e. output or dependent variable) when provided with

26

input data (i.e. independent variables) that have a measurable causal or coincident
relationship to the output. In order for predictive modelling to be useful in a given
application, two fundamental principles must hold:
i. Outcomes must have some level of predictability from known data. That is, similar
patterns represented across model inputs should be indicative of similar outputs;
ii.

There exist some measurable relationship between the set of known data values
that will be used as model inputs and the resulting output value(s) that the
model is tasked to approximate; and

iii.

Relationships that existed in the past will continue to hold in the future such that
it is reasonable to use past observations to infer future behaviour.

When these principles are adhered to, predictive modelling can approximate the
relationship between the known input data measures and the resulting output.
2.5.3

Predictive modelling applications

There are generally two classes of predictive modelling applications that differ by the
type of output the model produces:
i.

Forecasting: Forecasting model generate outputs that are continuous-valued. That is,
the output should be a value ranging from the minimum to the maximum
allowed. These models are used in applications such as forecasting/estimating:
sales, volumes, costs, yields, rates, temperatures, scores, etc. and

ii.

Classification: Classification models generate outputs that are 1-of-n discrete

possible outcomes. Often there is a single output that represents a Boolean (i.e.,
yes/no) outcome. These models are used in pattern recognition applications to
do fraud detection, target recognition, vote forecasting, prospect classification,
churn prediction, bankruptcy prediction, etc. This is the preferred methodology
for the implementation of the predictive model for the intended system.

27

2.6

Related Works

A few number of prediction systems exists concerning Diabetes Mellitus and other
related diseases such as Cardiovascular diseases prediction with varying factors and
data mining methodology applied.
2.6.1

A Machine Learning Approach to Predicting Blood Glucose Levels for

Diabetes Management

This system, Kevin P. et al (2014), describe a solution that uses a generic

physiological model of blood glucose dynamics to generate informative features for a
Support Vector Regression model that is trained on patient specific data. The new
model outperforms diabetes experts at predicting blood glucose levels and could be
used to anticipate almost a quarter of hypoglycaemic events 30 minutes in advance.
Although the corresponding precision is currently just 42%, most false alarms are in
near-hypoglycaemic

regions

and

therefore

patients

responding

to

these

hypoglycaemia alerts would not be harmed by intervention (Kevin P. et al., 2014).

2.6.2

Intelligent Heart Diseases Prediction System (IHDPS) using Weighted

Associative Classifiers
Jyoti et al (2011) designed the IHDPS system as a GUI based Interface to enter the
patient record and predict whether the patient is having Heart diseases or not using
Weighted Association rule based Classifier. The prediction is performed from mining
the patients historical data or data repository. In Weighted Associative Classifier
(WAC), different weights are assigned to different attributes according to their
predicting capability. The system has been implemented in java Platform and trained
using benchmark data from UCI machine learning repository. The system is
expandable for the new dataset.

28

The system is a Web-based, user-friendly, scalable and reliable that can be

implemented in remote areas like rural regions or countryside, to imitate like human
diagnostic expertise for treatment of heart ailment. The system is expandable in the
sense that more number of records or attributed can be incorporated and new
significant rules can be generated using underlying Data Mining technique. Presently
the system has been using 13 attributes and 303 records only and the data is from UCI
machine learning dataset that is mainly used for research purpose. As the symptoms
that cause a particular disease may vary from region to region, the system should be
trained using local dataset collected from the clinic.
2.6.3

Decision Support in Heart Diseases Prediction System (DSHDPS) using

Nave Bayes
The DSHDPS was developed by Subbalakshmi et al (2011) using Naive Bayesian
Classification technique. The system extracts hidden knowledge from a historical
heart diseases database. It is one of the most effective models to predict patients with
heart diseases. This model could answer complex queries, each with its own strength
with respect to ease of model interpretation, access to detailed information and
accuracy. DSHDPS can be further enhanced and expanded. For, example it can
incorporate other medical attributes besides the one used. It can also incorporate other
data mining techniques. Continuous data can be used instead of just categorical data.

29

Table 2.1

Table of related works to Diabetes Mellitus Prediction

S/N
1.

Author(s)
Kevin
P,
Razvan
B,
Cindy M, Jay
S, and Frank S.
A. (2014)

Research Title
A
Machine
Learning
Approach
to
Predicting Blood
Glucose Levels
for
Diabetes
Management

Scope
Blood
Glucose
Levels

2.

Jyoti
Soni,
Uzma Ansari,
Dipesh
Sharma,
Sunita
Soni
(2011)

Heart
Disease
Predictio
n

3.

G.Subbalaksh
mi,
MTech,
K.
Ramesh,
MTech,
M.
Chinna Rao,
PhD (2011)

Intelligent and
Effective Heart
Disease
Prediction
System
using
Weighted
Associative
Classifiers
Decision
Support in Heart
Disease
Prediction
System
using
Naive Bayes

Heart
Disease
Predictio
n

Strengths
The system incorporate
Support Vector
Regression (SVR) model,
informed by a
physiological model and
trained on patient specific
data, has outperformed
diabetes experts at
predicting blood glucose
levels and can predict
23% of hypoglycaemic
events 30 minutes in
advance
The system incorporates
patient health record with
a
detailed
genetic
analysis. There is a need
to combine these factors
to provide a better overall
determinant of risk.
The
system
extracts
hidden knowledge from a
historical heart disease
database. It is one of the
most effective models to
predict patients with heart

Limitations
The SVR system was
able to predict 23% of
the
hypoglycaemic
events with a false
positive rate under 1%.

Remarks
The system performs
prediction using blood
glucose datasets collected
from Type 1
DM
patients
and
SVR
model with Physiological
features

The
prediction
is
performed from mining
the patients historical
data, which is from
UCI machine learning
dataset,
which
is
mainly
used
for
research purpose.
The system uses only
categorical
data
without incorporating
continuous data.

The system performs

prediction using patients
health
history
and
Weighted
Association
rule based Classifier.

The system is developed

using Naive Bayesian
Classification technique.
The model could answer
complex queries, each
with its own strength

30

disease. It is implemented
as
web
based
questionnaire application
and can serve as a training
tool to train nurses and
medical
students
to
diagnose patients.
4.

S. Pruna, N. D. One-Side
Harris, and R. Desktop
Dixon,(2000).
Diabetes
Monitoring
System

Diabetes
The system improves the
Monitorin quality
of
diabetes
g System services by providing the
clinicians
with
a
computerized
diabetes
registry. The clinicians
have many options for the
management
of
the
creation, correction, and
visualization of patients'
records.

with respect to ease of

model
interpretation,
access
to
detailed
information
and
accuracy.

They use a MS access

related tables to store
information in the
database, which in now
obsolete.

The
system
was
developed
using
a
modular design and
object oriented method
approach
and
its
architecture was based
on the Good European
Health Care Record
(GEHR)

31

CHAPTER THREE
RESEARCH METHODOLOGY
3.1 Introduction
The research methodology focused on the identification of the different variables required
for predicting the risk of T2DM in patients from Specialist in the College of Medicine,
Obafemi Awolowo University, Ile Ife via the use of structured interview followed by the
formulation of the fuzzy logic based model for predicting the risk of T2DM in such
patients through the use of MATLAB fuzzy logic toolbox.
3.2 Variables Description
In this study, the work is limited to six paramount risk factors of the T2DM only since the
work is intended to provide a system, which aids preventive medicine via the earlier
detection of the disease risk. The causatives variables of T2DM were classified according to
the groups that they belong to and may only be used to identify the status of the individual
risk to these groups (see Table 3.1).
The risk factors of those set of variables that help in the identification of the risk of T2DM
include:
i.

Body Mass Index (BMI): this is a measure of the ratio of the height (in meters) to
the square of the weight (in Kg) used in identifying the likelihood of obesity. The
risk of diabetes and cardiovascular disease increases and the body mass index

ii.

increases.
Age: this is another major determinant of the Type 2 Diabetes Mellitus disease
because the higher the age (from 30 years old) the higher the likelihood of the

iii.

T2DM disease.
Family History of Diabetes: This is another identification of the existence of
family members who have had T2DM or are still living with the disease. The risk

32

of T2DM increases with the existence of family members especially the first
iv.

generation members.
Blood Pressure: this is the measure of systolic and diastolic blood pressure of the
individual and has a benchmark. The risk of T2DM increases with the increase in

v.

blood pressure.
History of Gestational Diabetes: Gestational diabetes is the type of diabetes that
usually affects the women during pregnancy. The risk of T2DM increases with

vi.

patient that has had occurrences of Gestational Diabetes.

Gender: The recent data have also shown that men develop type 2 diabetes at a
lower degree of obesity than women a finding that adds support to the view that
the pathogenesis of type 2 diabetes differs between men and women.
Observations of sex differences in body fat distribution, insulin resistance, sex
hormones, and blood glucose levels further support this notion (Frch, K., 2014).

33

Table 3.1
S/N
1.

Risk Factors Associated with T2DM

Risk Factors
Family History of T2DM

Labels
None/ 3rd Generation, 2nd

2.

Age

Generation, 1st Generation

30, 30 45, >45

3.

Body Mass Index (BMI)

Normal ( 24.9), Overweight (25.0

4.

History of Gestational

29.9), Obesity (30.0).

Negative, Positive

5.

Diabetes
Blood Pressure

Normal, Pre-hypertension, High.

6.

Gender

Male, Female

34

3.3 The mathematical model used for T2DM prediction

The front-end via which the user will be communicating with the system requires certain
rules which consists of a combination of values of labels of each risk factors required by the
system in determining the status of the patients Type 2 diabetes mellitus status. The Fuzzy
Logic model used in developing the T2DM prediction system is a qualitative computational
approach, which describes uncertainty or partial truth. Fuzzy logic has ranging value of 0
and 1 that corresponds to the degree of truth. Every set that does not reflect a crisp set, but
has clearly defined boundary is a fuzzy set. Fuzzy sets represents simple linguistic concepts
like yes-no, true-false, low-medium-high, etc. A given element may belong to more than one
fuzzy set at the same time, because the theory of fuzzy sets us a theory of graded concepts
and membership elasticity (Idowu P. A., et al, 2015). All fuzzy sets are characterized by
membership functions a curve that defines how each point in the input space is mapped to
a membership value or degree of membership between 0 and 1. The input space is
sometimes referred to as the universe of discourse (Mathwork, 2011)
For the purpose of this study, there is need to make a general description of the mathematical
model of the proposed fuzzy logic model that was used. The mathematical model of the
fuzzy logic was used to generate the membership functions that were used to map the label
of each variable to their respective fuzzified value using a process called fuzzification. The
membership function that was used in this study in fuzzifying the variables (input and
output) is the triangular membership function in equation 3.1;this function maps the label of
each variable using a triangular shaped function which uses three (3) points to define the
two (2) base points and one (1) apex point. The apex point is usually defined by using a
parameter between the two base points.
The mathematical representation of the triangular membership function used to map the
labels of each variables (input and output) is as follows:

35

0,x a
xa
, a x b
ba
f ( x ; a , b , c) =
(3.1)
cx
,bx c
cb
0, c x
or

( (

f ( x ; a , b , c ) =max min

xa cx
,
, 0 (3.2)
ba cb

) )

Where a and c are the base of the triangle and b is the apex point of the triangle, and x is the
label value within the interval a and c
In this study, all variables were divided into three labels each represented by its own
triangular membership functions defining their respective base points and apex points. Thus,
in the process of fuzzification all variables were mapped using the following membership
functions as defined below, for the three (3) labels of each variable and that of two (2) labels
of each variable as follow in equations 3.3, 3.4, 3.5, 3.6, and 3.7 respectively:
For the variables with two labels, the membership functions will be:
label 1=f ( x ; 0.00, 0.25,0.5 ) .(3.3)

label 2=f ( x ; 0.50, 0.75,1.00 ) ..(3.4)

While for the variables with three labels, the membership functions will be:
label 1=f ( x ; 0.00, 0.16,0.33 ) ..(3.5)

label 2=f ( x ; 0.33, 0.49,0.66 ) .(3.6)

label 3=f ( x ; 0.66, 0.83,1.00 ) .(3.7)

36

3.4 Fuzzy Logic Model for Predicting Type 2 Diabetes Mellitus Disease Risk
The fuzzy logic model for predicting the risk of T2DM involves the process of fuzzification
defining the input and output variables in the Fuzzy Inference System (FIS), construction
of rule-based for the inference engine, the aggregation of the rules and then the
defuzzification of the results of the aggregated membership function.
The first process in modelling a fuzzy logic system is Fuzzification, and this is used to
convert each of input data to a degree of membership function in the MATLAB fuzzy logic
toolbox. Thus, the triangular membership function is chosen for fuzzification of both inputs
and output variables. In the process of fuzzification, each input data was mapped with the set
of rules to establish the degree of fitness on how each rule matches the particular input. It is
to be noted that the triangular membership function was used to map the degree of
membership of the labels of each variables used for input and output variables.
The schematic representation of the fuzzy logic system for T2DM disease risk predicting
system in figure 3.1 below shows the set of variables used as inputs ofr the model and the
risk as the output variable for the system.

37

Body Mass Index (BMI)

Age

Rule 1
Rule 2
Rule 3

Rule N
Rule N

AGGREGATION

DEFUZZIFICATION

Family History of Diabetes

(All
Rules
are aggregated
output variable
T2DM DISEASE
RISK
INFERENCE
ENGINE into a single fuzzified
Type 2 Diabetes Mellitus Risk Predic
Using
ZIFICATION (Use Triangular Membership Function to map the variables to their respective label
(Low, Moderate, High)
= Value) AND (Body-Mass-Index = value) AND (Age = value) AND (History-of-Gestational-Diabetes = value) AND (Blood-Pressure = Value) AND (Gender = value) THEN (
History of Gestational Diabetes

Blood Pressure

Gender
Figure 3.1: Schematic Representation of the T2DM Disease Risk Inference System

38

3.5 Simulation Environment

The schematic representation of the Type 2 Diabetes Mellitus Disease Risk inference engine
shown in the figure 3.1 above shows different factors of T2DM as input to the fuzzy logic
model for determining the risk of the disease (Type 2 Diabetes Mellitus), and the output
variable is determined by the fuziffication of the input variables using Triangular
Membership function to map the variables to their respective label. Table 3.1 shows the
description of the fuzzification of input variables for T2DM Disease using the mathematical
model in equation 3.1 to plot the fuzzified values and equations 3.3 and 3.4 for variables
with two labels, while equations 3.5, 3.6, and 3.7 for variables with three labels. Table 3.2
shows the fuzzification of the input variables (i.e. risk factors) needed for determining the
risk of Type 2 Diabetes Mellitus disease .
The simulation environment for the Type 2 Diabetes Mellitus Disease risk predicting system
was carried out using the MATLAB API. The formulation of the model was done by using
the MATLAB fuzzy logic toolbox. The MATLAB fuzzy logic toolbox contains fuzzy
inference system (FIS) editor that was used to define both the input and output variables.
The input variables consist of six (6) input labels with three (3) or two (2) triangular
membership function as shown in figure 3.2 below, while the output variables consist of 3
membership functions. The rule editor interface was used for the rule-based of the interface
inference engine of FIS showing the relationship between the six (6) input variables and the
output variables using IF THEN rules. The AND method was used for the minimum label
value and the IMPLICATION method used was also for the minimum, while the
AGGREGATION method used was maximum, and Deffuzification method is centroid
which combine all the various aggregated values into a single value which is later supplied
as output of the system.

39

Table 3.2

S/N
1.

The Fuzzification of T2DM Disease Risk Input (Risk Factor)

Risk Factors

Labels

Fuzzy Logic Value

Family History of T2DM

None/ 3rd Generation,

0.16

nd

4.

Age

7.

Body Mass Index (BMI)

2 Generation,

0.49

1st Generation

0.83

30
30 45
> 45
Normal ( 24.9)

0.16
0.49
0.83
0.16

Overweight (25.0 29.9)

0.49

Obesity (30.0)
Positive

0.83
0.75

11.

Blood Pressure

Normal,
Pre hypertension
High

0.16
0.49
0.83

14.

History of Gestational

Negative

0.25

Male
Female

0.25
0.75

Diabetes
15.

Gender

40

Figure 3.2

Fuzzy Inference System for Prediction of risk of T2DM

41

3.6 System Requirement

System requirements are an important aspect of system development and they are used to
specify details of system functions, services and the basis for designing the system. These
requirements were used to discover and clarify the function of the system. This segment
consists of the feasibility study, the specification and analysis of requirements, and project
definition. Therefore, the scope of the system requirement of the predicting system covers
the following areas:
i.

Identify the factors affecting diabetes mellitus disease and their corresponding
influence. This is to highlight the factors that are considered to be associated with
diabetes mellitus disease and how significance their influence is so that an accurate

ii.

predictive model can be formulated.

Represent and document the activities to be carried out by the type 2 diabetes
mellitus disease risk predicting system and the corresponding entities. After
identification of the factors and their corresponding influences, there is a need to
represent the activities and entities involved with the system and document the

iii.

information.
Generate a model using fuzzy logic approaches. The model was developed by

iv.

identifying the variables that are required in type 2 diabetes mellitus disease.
Develop a prototypical type 2 diabetes mellitus disease risk predicting system with
using fuzzy set approaches. Efforts were made to ensure that the system is able to
predict the likelihood of occurrence of diabetes mellitus disease.

The system aim to assist doctor in predicting the patient type 2 diabetes mellitus disease risk
status thereby reduces the number of people coming to the hospital and easing the doctors
task. It will also allow people to know how prone they are to developing type 2 diabetes
mellitus disease without visiting the hospital based on their body mass index, blood
pressure, sedentary lifestyle, health history and their current health status, though some
information will still be needed from the doctor for accurate prediction.

42

3.7 Simulation Tools

For the simulaton of the proposed model, the Fuzzy Logic Toolbox available in the
MATLAB R2013a software will be used. The MATLAB Fuzzy Logic Toolbox consist of
FIS editor, Membership Function Editor, Rule Editor, Rule Viewer, Surface Viewer, and the
Fuzzy Inference System (FIS) at the centre of the whole system (Mathworks, 2013).
i.

Fuzzy Inference System Editor: The MATLAB fuzzy logic toolbox contains fuzzy
inference system (FIS) editor that was used to define both the input and output
variables. The FIS Editor handles the high-level issues for the system by determining
the number of input and output variables alongside their names. The Fuzzy Logic
Toolbox does not limit the number of inputs. However, the number of inputs may be
limited by the available memory of the machine. If the number of inputs is too large,
or the number of membership functions is too big, then it may also be difficult to

ii.

analyse the FIS using the other GUI tools.

The Membership Function Editor is used to define the shapes of all the membership

iii.

functions associated with each variable.

The Rule Editor is for editing the list of rules that defines the behaviour of the

iv.

system.
The Rule Viewer and the Surface Viewer are used for looking at, as opposed to
editing, the FIS. They are strictly read-only tools. The Rule Viewer is a MATLAB
based display of the fuzzy inference diagram shown at the end of the last section.
Used as a diagnostic, it can show (for example) which rules are active, or how

v.

individual membership function shapes are influencing the results.

The Surface Viewer is used to display the dependency of one of the outputs on any
one or two of the inputs that is, it generates and plots an output surface map for
the system.

43

Figure 3.3

FUZZY LOGIC TOOLBOX

44

3.8 System Operational Requirements

3.8.1

Hardware Requirements

For the proper functioning of the diabetes mellitus disease risk prediction system, the
following items will be needed for the hardware:
a. A Computer with internet access and at least a Pentium III processor;
b. An input and pointing device;
c. A hard Disk of at least 1GB of size is required in order for the repository to run well
without congesting other programs; and
d. Random Access Memory of at least 512MB is required.
3.8.2

Software Requirements

The following software will be needed for the proper functioning of the diabetes mellitus
disease risk prediction system:
a) Windows Operating System (Wins. 7 and above).
a) MATLAB Fuzzy Logic Toolbox

45

CHAPTER FOUR
TYPE 2 DIABETES MELLITUS DISEASE RISK MODEL DEVELOPMENT
4.1 Simulation of the Fuzzy Logic Model for Predicting Type 2 Diabetes Mellitus
Disease Risk
The simulation of the fuzzy logic model for the prediction of Type 2 Diabetes Mellitus
disease risk was simulated using the fuzzy logic toolbox available in the MATLAB 2013
Development Environment. Using the formulated triangular membership functions defined
for each input and output variable, the membership functions and the respective fuzzy
inference model for the risk of T2DM using six risk factors as shown in figure 3.2 above
were used as the inputs. The triangular membership functions in figures

46

Figure 4.0:

Membership function of Family History

47

Figure 4.1: Triangular Membership Function of Age

48

Figure 4.2: Triangular Membership Function for Body Mass Index

49

Figure 4.3: Triangular Membership Function for History of Gestational Diabetes

50

Figure 4.4: Triangular Membership Function for Blood Pressure

51

Figure 4.5: Triangular Membership Function for Gender

52

Figure 4.6: Triangular Membership Function for the risk of T2DM

53

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