DEVELOPING AND OPTIMIZING A MACHINE LEARNING

BASED DIABETIC DIAGNOSTIC SYSTEM THROUH

ALGORITHM PERFORMANCE ANALYSIS

BY
ORIERE EMMANUEL OGBEMUDIA
20201231842
&
NOKWAMCHUKWU JOSHUA NKWACHI
20201207682

A PROJECT PRESENTED TO THE DEPARTMENT OF

INFORMATION TECHNOLOGY, FEDERAL UNIVERSITY OF
TECHNOLOGY, OWERRI

IN FULFILMENT OF THE REQUIREMENTS FOR THE AWARD

OF BACHELOR OF TECHNOLOGY (B. TECH) DEGREE IN
INFORMATION TECHNOLOGY

JULY 2025.
 CERTIFICATION
I certify that this research work “DEVELOPING AND OPTIMIZING A MACHINE
LEARNING BASED DIABETIC DIAGNOSTIC SYSTEM THROUGH ALGORITHM
PERFORMANCE ANALYSIS” was carried out by Oriere Emmanuel Ogbemudia
(20201231842) & Nokwamchukwu Joshua Nkwachi (20201207682) in partial fulfilment for the
award of the degree of B. Tech in Information Technology, of the Federal University of
Technology, Owerri.

_______________ ________________
Project Supervisor. Date
(Mr. Asimobi)

________________ ________________
Dr. E.C Amadi Date
(Ag. HoD -IFT)

________________ ________________
Prof. U.F Ezeh. Date
(Dean, SICT)

________________ ________________
(External Examiner) Date
 DEDICATION
This work is dedicated to almighty God for seeing us through and provision for the completion
of this work.
 ACKNOWLEDGEMENT

First and foremost, we give glory to God Almighty for His divine wisdom and strength that
sustained us throughout this academic journey and the completion of this work.

We are grateful to our project supervisor, Mr. Asimobi, whose unwavering support and
guidance shaped each phase of this work. His patience in reviewing our work, and constant
corrections were important in handling difficulties during the research process of this work.

Special appreciation goes to Engr. Dr. E. C. Amadi, our Head of Department, for creating an
enabling academic environment. His leadership ensured we had access to necessary institutional
support to carry out this project effectively.

We are particularly thankful to Mr. Victor, our Data Science lecturer, whose teachings laid the
technical foundation for this work. His practical sessions on Python programming, Scikit-learn,
and model evaluation directly helped our implementation of the diagnostic system.

To the entire faculty and staff of the Department of Information Technology at the Federal
University of Technology, Owerri we say thank you. We are grateful for your dedication to
knowledge impartation and for maintaining a conducive learning environment throughout our
studies in FUTO.

To our beloved families, we owe gratitude for their constant prayers, and financial support, that
kept us motivated during demanding periods of this project.

Finally, we appreciate all our colleagues and friends who offered feedback during discussions
and shared in their thoughts and ideas. Their companionship made this journey memorable.
 ABSTRACT
Diabetes is a crucial health crisis in Nigeria and other developing African countries, with
prevalence surging from 2.2% to 7.0% over two decades and more than 60% of cases remains
undiagnosed until complications arises (Nigerian Medical Journal, 2023). Existing tools for
diagnostic faces major limitations they either rely on costly lab tests (₦25,000 per HbA1c) or
deploy suboptimal machine learning models without optimization for African populations
(Adeoye et al., 2023). This research addresses these gaps by developing and optimizing a
machine learning based diagnostic system through model comparison.

This research implements five major phases First, benchmark datasets (dataset + synthetic
Nigerian data) are preprocessed with SMOTE balancing. Second, five classification algorithms
(KNN, SVM, Random Forest, Logistic Regression, Decision Tree) are comparatively evaluated
using clinical metrics (AUC-ROC, Recall, Precision). Third, Bayesian Optimization fine-tunes
the highest-performing model to achieve ≥90% recall and ≥0.93 AUC. Fourth, the optimized
model is deployed via a Django web interface with offline functionality. Finally, validation
against WHO standards confirms diagnostic accuracy. Expected outcomes include a 75%
reduction in screening costs compared to traditional methods and a 40% decrease in undiagnosed
cases accessible, high-accuracy (≥89%) diagnosis. By integrating the most performing algorithm
with context-aware design, this system offers a scalable solution to diabetes diagnostic while
establishing a framework for clinical AI deployment in low-resource settings.
 TABLE OF CONTENT

CERTIFICATION...........................................................................................................................2
DEDICATION.................................................................................................................................3
ACKNOWLEDGEMENT...............................................................................................................4
ABSTRACT....................................................................................................................................5
TABLE OF CONTENT...................................................................................................................6
LIST OF TABLES...........................................................................................................................7
LIST OF FIGURES.........................................................................................................................8
CHAPTER ONE..............................................................................................................................9
INTRODUCTION...........................................................................................................................9
Background of Study...................................................................................................................9
Statement of the Problem...........................................................................................................10
Aim and Objectives...............................................................................................................12
Significance of the Study...........................................................................................................13
1.5 Scope of the Study...............................................................................................................14
Limitations of the Study............................................................................................................15
Definition of Key Terms............................................................................................................16
CHAPTER TWO...........................................................................................................................18
LITREATURE REVIEW..............................................................................................................18
2.1 Conceptual Framework........................................................................................................18
2.1.1 Diabetes Mellitus: Definition, Cause and Impact.........................................................18
 2.1.2 Brief Definition of Data Science and ML.....................................................................19
AI in Diabetes Management..................................................................................................21
2.1.4 Web Based Health Solution for Diabetes Management...............................................21
2.2 Theoretical Framework........................................................................................................22
2.2.1 Algorithm Selection Theory.........................................................................................22
2.2.3 Human Computer Interaction (HCI) Principles for Health Applications.....................24
Empirical Review......................................................................................................................25
2.3.1 Wearable IoT System (7 studies)..................................................................................25
2.3.2 Mobile Applications (7 studies)....................................................................................26
2.3.3 Web Based Systems (7 studies)....................................................................................27
2.4 Summary of Literature Review...........................................................................................27
2.4.1 Gaps Identified from Literature Review.......................................................................29
CHAPTER THREE.......................................................................................................................30
METHODOLOGY........................................................................................................................30
3.1 Methodology Adopted: Design-Based Research Framework.............................................30
3.2 System Analysis of the Existing System.............................................................................31
3.2.1 System Architecture......................................................................................................31
3.2.2 Algorithm Implementation...........................................................................................34
3.3 Proposed System Design.....................................................................................................36
3.3.1 System Architecture Overview.....................................................................................36
3.3.2 Model Development Process........................................................................................38
3.3.3 Key Component Specifications....................................................................................40
3.3.4 User Interface Workflow..............................................................................................43
3.4 Tools and Technology to be used in designing Proposed System.......................................44
 LIST OF TABLES
Table Title Page
2.1 Summary of literature review 28
3.1 Existing system deployment architecture 35
3.2 Performance of existing system on the PIMA data set 36
 LIST OF FIGURES
Figure Title Page
3.1 DBR processes 31
3.2 Core components of Existing system 33
3.3 Flow chart diagram showing proposed system architecture 35
3.4 Flow chart showing model selection phase 39
3.5 Performance of existing system on the PIMA data set 36
 CHAPTER ONE

INTRODUCTION

Background of Study
Massive changes and researches have been done globally on health from the onset of civilization
till now (21st century). From communicable diseases to non-communicable diseases like
diabetes. Twenty years ago, health officials were concerned about sickness like malaria,
tuberculosis, fever etc., But today diabetes has become a major global health challenge. Last two
years, the International Diabetes Federation (2023) estimated about 537 million adults living
with diabetes. What’s concerning is how fast its spreading in developing countries like Nigeria
and other African countries.
The study to understand diabetes traces back to thousands of years ago. The ancient Egyptians
doctors described the condition in papyrus, scrolls, stating how ants were attracted to the urine of
a diabetic patient ( Ekoe et al., 2020). Early detection relied on subjective symptom analysis like
excessive thirst, fatigue and crude urine test ( Ekoe et al., 2020). Fast forward to today, we’ve
gotten fancy machines that can check blood sugar in seconds. But the most accurate test still
relies on expensive lap equipment and trained technicians. In many Nigeria clinic patients waits
few days to just to get their HbA1c results (Perkins, 2023). There’s got to be a better way.
Additionally, things have changed when computers today start’s using analysis of patterns to
diagnose and predict future health risks in patients even before they occur. AI has disrupted
healthcare improving diagnostic accuracy and operational efficiency. An AI system at Lagos
Teaching Hospital caught early signs of diabetic eye damage that three specialists missed
(Adeola et al., 2024). In the health sector today, AI systems are playing major roles in improving
patient’s health from early diagnosis to monitoring systems. AI reduces diagnostic delays by
40% in resource limited settings (Nature Digital Medicine, 2023), making it ideal for diabetic
management.
Machine Learning role in diabetes diagnosis/prediction began with logistic regression models in
the 1990s, which evolved and is still evolving to complex models like Random forests and
XGBoost. Recent studies demonstrate Random forest achieve 91% AUC in diabetes screening
(Alghamdi et al., 2023), SVM models predicts prediabetes 6 months earlier than traditional
methods (Zhang et al., 2024). What excites me most is how these tools keep improving each year
bringing new algorithms that predicts health risks earlier and more accurately.

Finally, i would say that this project comes at a crucial time. With diabetes spreading faster than
our clinics can handle. We need solutions that are smart and also accessible. By training and
testing different ML models and deploying the best into simple web tools. Which creates a
system that helps both doctors and regular people control diabetes before it’s too late.

Statement of the Problem

Globally, from statistics diabetes kills someone every 6 seconds more than HIV and malaria
combined (IDF, 2023). In Nigeria, the situation is particularly worst. Current statistics from the
Nigerian Ministry of Health (2024) shows that diabetes related deaths have tripled since 2015,
with over 100,000 fatalities yearly. Studies have also shown that diabetes is the cause of most
people living with chronic sickness like kidney and other organ failures. Africa bears the severity
of this crisis while accounting for only 4% of global cases, it suffers 19% of diabetes deaths
(WHO Africa, 2023). What makes these numbers heart breaking is that over half could be
prevented with early diagnosis (Lancet Global Health, 2022), yet most Nigerian and other
Africans lack access to basic screening and tools.

Existing studies have shown great potential in the use of Machine Learning (ML) models in
improving diabetes diagnosis and reducing the mortality rate. But there are still significant
limitations and rooms for improvement in these models. Recent studies (2020–2025) highlight
advancements. Mburu et al. (2023) built an SVM-based mobile system in Kenya achieving 89%
accuracy for risk prediction using basic health parameters, while Van der Merwe (2024) reduced
screening costs by 60% in South Africa with a Random Forest model, deep learning solutions
like ‘Deep Hit’ have outperformed traditional statistical methods in predicting mortality rate,
achieving a C-index scores of 0.73 and Brier scores of 0.09 in the UK Biobank cohort. However,
these models rely strongly on single algorithms without comparison with other algorithms or
optimization, leading to suboptimal accuracy (e.g., Gluco Care's 65% accuracy in Ghana). They
also neglect region-specific factors like Nigerian dietary patterns (e.g., high-glycemic staples
such as garri) and fail to solve infrastructure challenges such as outages in power that disrupt
real-time monitoring in low-resource settings. Additionally, most tools prioritize monitoring over
diagnosis and lack clinical deployment readiness, limiting their lifesaving potential.

But this study focuses on bridging these gaps in the existing system by developing a machine
learning system optimizes and deploys the highest performing algorithms for diabetes diagnosis.
Unlike prior works and existing systems this approach will:
Compare five classification algorithms (KNN, SVM, Random Forest, Logistic Regression,
Decision Tree) using standardized clinical metrics (AUC-ROC, Accuracy, Precision and F1-
score) on datasets integrating Nigerian specific variables like local diets, stress markers, and
lifestyle factors.
Hyperparameter tune the most performing model using Bayesian Optimization to maximize
accuracy addressing the "suboptimal performance" gap noted in recent literature, where untuned
models forfeit up to 7% potential accuracy.
Integrate the optimized model into a Django based web interface for low-bandwidth
environments, enabling accessible diagnosis without IoT dependency. This system aims to
reduce screening compared to lab-based HbA1c tests (₦25,000/test) and cut undiagnosed cases
through proactive risk alerts. By prioritizing accuracy, local relevance, and clinical usability, our
solution directly aims at addressing the limitations of current ML tools and aligns with WHO
goals for equitable diabetes care.
Aim and Objectives
Aim
The main aim of this study is to compare, optimize, and develop a high accuracy machine
learning based diagnostic system for diabetes.
Objectives
(i) To collect and preprocess benchmark diabetes datasets including Nigerian specific
variables (dietary patterns, lifestyle factors, and biometric markers) from publicly
available repositories and synthetic data generators.
(ii) To design, train, and comparatively evaluate five machine learning models (KNN,
SVM, Random Forest, Logistic Regression, Decision Tree) using the following
clinical performance metrics (Accuracy, Precision, Recall F1 score and AUC-ROC).
(iii) To optimize the highest performing model using Bayesian Optimization for
hyperparameter tuning and SMOTE for class imbalance correction
(iv) To deploy the optimized model using Django with offline functionality for low-
resource and low bandwidth settings, enabling accessible diagnosis without IoT
dependencies.

Significance of the Study

This study will improve diabetes diagnosis by providing a diagnostic tool that costs 90%
less than traditional lab tests. By deploying an optimized ML model using Django, community
health centers across Nigeria will gain capacity to screen patients for diabetes with 93%
accuracy using only basic smartphones eliminating the need for ₦25,000 HbA1c tests or
specialist consultations. This directly addresses WHO Africa's (2024) priority to reduce
undiagnosed diabetes rates by 50% before 2030, potentially preventing thousands of annual
diabetes related amputations and kidney failures through early detection.
Additionally, researchers will benefit from this study that resolves a crucial gap in medical AI
development. By implementing how Bayesian Optimization boosts algorithm performance by 7-
12% compared to conventional tuning methods, this study provides a reproducible framework
for hyperparameter optimization in clinical applications. The open-sourced codebase will enable
other scientists to validate findings using Nigerian datasets, addressing the "reproducibility
crisis" in African health AI noted by Nature Digital Medicine (2025). The comparative analysis
of five algorithms also creates the first performance baseline for diabetes diagnosis specific to
Sub-Saharan populations
Lastly, Information Technology students will gain insights into end-to-end clinical AI
deployment through this project. Final-year projects in our department can adapt this
methodology for other diseases, while course instructors may incorporate the optimization
techniques into machine learning curriculum bridging the gap between theoretical algorithms and
real-world healthcare application context.
1.5 Scope of the Study
This research is strictly focused on developing a machine learning system for diabetes
diagnosis rather than treatment. The study will compare five classification algorithms including
KNN, SVM, Random Forest, Logistic Regression, and Decision Tree using clinical metrics
including Accuracy, Precision, Recall, F1-Score, and AUC-ROC to determine the optimal
diagnostic model. The data parameters will encompass fundamental health indicators like age,
BMI, glucose levels, blood pressure, and lifestyle factors, while intentionally excluding genetic
markers or advanced biomarkers that require laboratory processing to maintain accessibility in
low-resource settings.

The technical scope focuses on implementing Bayesian Optimization for hyperparameter tuning
and developing a Django based interface compatible with standard desktop and mobile browsers,
without extending to native mobile applications or real time monitoring systems. It's important
to note that this research will not track longitudinal patient outcomes after diagnosis, nor will it
develop treatment recommendations or medication protocols.

Finally, the study specifically targets adult populations aged 18 years and above who exhibit
early diabetes symptoms, excluding pediatric and gestational diabetes cases from consideration.
While incorporating Nigerian contextual factors like dietary patterns and healthcare access
limitations, the system will not integrate with hospital EMR systems or conduct economic impact
analyses.

Limitations of the Study

Basically, this research faces significant data limitations due to reliance on publicly available
datasets like the Pima Indian Diabetes Database rather than real-time Nigerian patient data.
While synthetic augmentation techniques will incorporate local factors like dietary patterns, the
absence of clinically validated Nigerian health records may reduce model generalizability across
Africa's diverse populations. As noted by Adeoye et al. (2023), public diabetes datasets often
underrepresent key African biometric variations, potentially creating accuracy disparities of 5-
7% when deployed in clinical settings.
Furthermore, the study encounters computational limitations since Bayesian optimization and
multi algorithm training require substantial processing power. The model development phase
demands systems with minimum 16GB RAM and GPU support requirements which exceeds the
typical Nigerian university lab capabilities.

Definition of Key Terms

Diabetes Mellitus: A chronic metabolic disorder characterized by elevated blood glucose levels
resulting from defects in insulin secretion, insulin action, or both, leading to serious
complications like kidney failure and cardiovascular disease if undiagnosed (WHO, 2023).
 Machine Learning (ML): A subfield of artificial intelligence where computer systems learn
patterns from data without explicit programming, enabling predictive analytics for diabetes
diagnosis through algorithms that improve with experience (Mitchell, 2021).

Bayesian Optimization: An advanced hyperparameter tuning technique that uses probabilistic

models to efficiently find optimal algorithm settings, reducing tuning time by 50% compared to
traditional methods while maximizing diagnostic accuracy (Snoek, 2023).

SMOTE (Synthetic Minority Over-sampling Technique): A data augmentation method that

generates synthetic samples for underrepresented classes (e.g., diabetic cases) to correct dataset
imbalances and improve model recall (Chawla et al., 2020).

AUC-ROC (Area Under Receiver Operating Characteristic Curve): A performance metric

ranging from 0 to 1 that evaluates a model's ability to distinguish between diabetic and non-
diabetic cases, with values ≥0.90 indicating clinical readiness (Alghamdi, 2023).

Django: A Python-based web framework following the Model-Template-View architecture,

used in this study to deploy the optimized ML model through browser-accessible interfaces
requiring no specialized hardware (Django Software Foundation, 2024).

Hyperparameter Tuning: The process of optimizing algorithm configuration settings (e.g., tree
depth in Random Forest) to enhance predictive performance, analogous to calibrating a medical
instrument for precise readings (Raschka, 2022).

Pima Indian Diabetes Dataset: A benchmark dataset containing diagnostic measurements from
Native American populations, serving as a proxy for Nigerian patients in this research due to
similar diabetes progression patterns (Smith et al., 2021).

Clinical Validation: The assessment process where the ML model's diagnostic outputs are
compared against gold-standard HbA1c tests to verify ≥89% agreement before deployment
(WHO, 2024).

Precision-Recall Tradeoff: The clinical balancing act where precision minimizes false alarms
(incorrect diagnoses), while recall minimizes missed cases - with this study prioritizing recall to
reduce undiagnosed diabetes risks (Perkins, 2023).
 CHAPTER TWO

LITREATURE REVIEW

2.1 Conceptual Framework

2.1.1 Diabetes Mellitus: Definition, Cause and Impact
Diabetes Mellitus is a chronic health disorder caused by high level of glucose (sugar) in the
blood due to inadequate production or use of insulin by the body. Insulin is a hormone produced
by the pancreas that helps to regulate blood sugar levels. Centuries ago Apollonius of Memphis
described diabetes as a disease which drains patients of more fluid than they can consume. The
word ‘diabetes’ was hence created, meaning to’ drain through. Also, around 129 – 216 AD Galen
of Pergamum, a Greek physician termed diabetes as an affliction of the kidneys. Majorly we
have two types of diabetes which includes:
(i) Type 1 diabetes: A condition where the body’s immune system destroys the insulin-
producing beta cells in the pancreas. This type typically develops in children and
young adults but can occur at any age. People with type 1 diabetes require lifelong
insulin therapy (American Diabetes Association, 2022).
(ii) Type 2 diabetes: This is a chronic condition defined first by resistance to insulin and
the gradual reduction in the production of insulin. Most commonly diagnose in adult
but increasingly found in children and young adults.

Additionally, Diabetes Mellitus causes serious medical disorders if not probably managed and
monitored. Ranging from cardiovascular diseases, nerve damage, kidney failure, vision
problems, and a higher risk of infection. It is also one of the major causes of premature
mortality (TODAY Study Group, 2021). Below are some of the major impacts:
(i) Cardiovascular disease: People with diabetes are at very high risk from
cardiovascular diseases, such as stroke, heart disease, and hypertension. High blood
sugar can lead to the damage of blood vessels and nerves in the heart (American heart
Association 2022).
(ii) Kidney Damage: A study by National Kidney Foundation in 2023 reviled that 30% of
patients with diabetes may develop kidney failure. Diabetes can impair normal kidney
operations which can result in kidney failure.
(iii) Problems with Vision: One of the impacts of diabetes not known to many is that
causes aliment like diabetes retinopathy and glaucoma which can lead to loss of
vision (Diabetes Association of Nigeria 2022).

2.1.2 Brief Definition of Data Science and ML

Data Science is a rapidly growing field in Information Technology, it encompasses areas like
Machine Learning, Artificial Intelligence, Computer Vision etc., I would define data science as a
discipline that uses statistical tool, mathematics, programming languages and domain specific
knowledge to draw insights from data.
Machine Learning on the other hand is a sub-domain of AI that specializes on the development
of algorithms and models that are trained and learns from data allowing computers to perform
tasks without being explicitly programmed.

Branches in Machine Learning (ML)

ML is categorized into three (3) major subsets. Each used for a specific problem. When
approaching a data science problem, first we need to understand the problem and know if it’s a
regression or classification problem then from there we can choose the right model or algorithm
that will effectively handle that problem.
The 3 major subsets of ML are:
(i) Supervised Learning: This is a type of learning where the model is trained on labeled
data sets (data set with input features and corresponding output labels). Common
techniques in supervised learning include regression algorithms (like linear
regression) and classification algorithms (like support vector machines and decision
trees). This approach has applications in areas such as credit scoring in finance,
disease diagnosis in healthcare, and customer segmentation in marketing (Kourentzes
et al., 2021).
(ii) Unsupervised Learning: These are models that learn from unlabeled data sets (data
sets with only input features). The algorithm identifies patterns and relationships in
the data. Used to detect anomalies in the data. Common techniques in unsupervised
learning include K-means and hierarchical clustering. Its Applications can be found in
market analysis, customer behavior discovery, and anomaly detection (García et al.,
2021). This type of learning is very useful when dealing with large datasets without
labels.
(iii) Reinforcement Learning: Here the model learns by interaction with the environment
by gaining or losing points. Widely used in areas such as robotics and autonomous
systems.
AI in Diabetes Management
With the rapid application of AI in different fields specifically health care it has revolutionized
traditional approaches, enhancing accuracy in prediction, monitoring, and treatment. With the
increasing prevalence of diabetes among young Nigeria youths, AI solutions has come and can
be utilized in solving this problem, breaching the gap of accessibility and affordability to
healthcare services. AI Enhances six (6) major domains of Diabetes Management which include:
(i) Diabetes management and treatment: AI personalizes diabetes treatment and insulin
dosage
(ii) Diagnostic and Imaging Technologies: AI improves precision in diabetes related
medical imaging.
 (iii) Health Monitoring system: this is the major focus of this project. AI improves real
time glucose monitoring and alerts.
(iv) Developing Predictive Models (Diagnosis): Predicts diabetes progression and
treatment responses.
(v) Prevention, Lifestyle, and Dietary Management: AI creates personalized dietary and
lifestyle advice to manage disease.
(vi) Enhancing clinical decision making: AI improves healthcare professionals decision

2.1.4 Web Based Health Solution for Diabetes Management

This proposed system utilizes web-based application instead of the normal IoT integration, these
provides better accessibility among most individuals because its affordably with just your phone
and an internet connection you will have access to the system. No need for spending money on
purchasing smart monitoring devices which might not be affordable by everyone (87% among
Nigerian citizens according to NCC 2023).
Major Advantages of Web-based Systems for Diagnosis
Here some major benefits of web-based systems in diabetes diagnosis over the use of IoT or
smart devices.
1. Cost Efficiency
(i) It eliminates the need for expensive health devices (saving ₦30,000-₦50,000
monthly on CGMs).
(ii) Reduces clinical visitations by 40% through remote monitoring (Adeoye et al.,
2022).
2. Scalability
(i) Can server multiple users at the same time.
3. Easy updates without physical distribution
4. Data centralization and Security:
(i) Enables secure cloud storage of patient histories

2.2 Theoretical Framework

2.2.1 Algorithm Selection Theory
The No Free Lunch Theorem (Wolpert, 2021) the theory states that:
"For any two learning algorithms A and A', there are equal numbers of problems where A
outperforms A' and where A' outperforms A when averaged over all possible problems."
This theory justifies testing five algorithms (KNN, SVM, RF, LR, DT) rather than presuming
superiority of any single approach.
Bias-Variance Tradeoff (Geman et al., 1992)
This theory explains why complex models (e.g., Decision Trees) may overfit clinical data while
simpler models (e.g., Logistic Regression) may underfit.
Mathematical Expression:
Total Error = (Bias)^2 + Variance + Irreducible Error
Bayesian Optimization Mathematics
Gaussian Process Regression (Snoek, 2023):
Core Concept: this Models unknown functions as probability distributions where similar inputs
yield similar outputs.
Key Equation:
Posterior Mean = k(x*,X)[K + σ²I]⁻¹y
where:
k = covariance function, X = observed points, y = observed values , σ² = noise variance
Expected Improvement (EI)
This theory operates by balancing the exploration of unknown regions with exploitation of
known good solutions.
Mathematical Definition
EI(x) = E[max(f(x) - f(x⁺), 0]] where x⁺ = current best solution.
Clinical Decision Theory
Pauker-Kassirer Threshold Model (2023)
Decision Rule:
Treat if P(Disease) > R/(R + B)
where: R = Risk of untreated disease, B = Risk of unnecessary treatment
Application to this study: R/B ratio ≈ 9:1 justifies 90% recall target.

2.2.3 Human Computer Interaction (HCI) Principles for Health Applications

Human Computer Interaction (HCI) is a sub-field within computer science that focuses on the
between people (users) and computer systems. It focuses on the interfaces between people and
computers. The main objective of HCI, is to make computer systems more user-friendly and
more usable.
In designing any system, it is imperative the system has a good UI/UX design to encourage
usability. Health applications must stick to this HCI principles because of the diverse number of
different users using the system. There are fundamental principles of HCI which includes the
following:
 (i) Cognitive Psychology: This is a specific field within psychology (The study of human
mind ang behavior) that studies mental processes such as memory, perception,
memory, and emotions. To study such processes, cognitive psychology applies
mathematical models to analyze data, experimental research models to observe
behaviors, and statistics.
(ii) Social Psychology: This is the scientific study of people’s feelings, thoughts, and
behaviors. Imported into HCI from the field of psychology, the social psychological
theories are useful for researchers in HCI to analyze situations involving groups of
people and how they may collaborate.
(iii) Ergonomics/Human Factors: A scientific discipline focused with understanding
interactions among humans and components of a computer system. This ensures that
people with various disabilities and limitations can effectively use the application.
This tends to improve usability of software applications.
In general, the understanding and application of these HCI principles in medical
systems/applications optimizes user performance while minimizing clinical risks (WHO, 2023).

Empirical Review
During the course of this research, 20 studies were systematically reviewed (2020 – 2025),
through Scopus, IEEE Xplore, Research Gate, Google Scholar, and PubMed using search key
words such as ‘Artificial Intelligence’, ‘Machine Learning’, ‘diagnosis’, and ‘diabetes’.
I grouped the literatures reviewed into 3 logical sub-headings.
2.3.1 Wearable IoT System (7 studies)
Advancements in wearable diabetic monitoring/diagnosis devices proved promising accuracy but
faced limitations in low-resource settings. Li et al. (2022) developed a CGM-integrated LSTM
model achieving 94% hypoglycemia prediction accuracy in US trials, but its ₦80,000/month
which is expensive for most Nigerian students. Similarly, Osei et al. (2023) created a smart ring
using random forests that detected 88% of Type 2 diabetic episodes in Ghana yet failed during
frequent power outages exceeding 4 hours. The European Medicines Agency (2023) approved a
non-invasive sweat glucose sensor with 91% accuracy, but its daily adjustment or calibration
requirement makes it impractical for students with erratic schedules. In India, Kumar et al.
(2021) combined smartwatches with CNNs to achieve 89% hyperglycemia detection, but this
relied on 5G connectivity which is not fully available in most Nigerian universities. A 2024
South African study by Van der Merwe et al. tested a patch-based IoT system that reduced
diagnosis costs by 30%, yet still required ₦45,000/month. Significantly, all six studies assumed
continuous cloud connectivity, ignoring Nigeria’s average 4.1-hour daily power outages (NBS,
2023).
2.3.2 Mobile Applications (7 studies)
Mobile solutions offer greater affordability but struggle with localization. Patel et al. (2022)’s
Indian app used SVM to analyze meal photos with 89% carb estimation accuracy, but its food
database excluded African staples like garri. The WHO’s 2023 SMS-based system achieved 73%
adherence across LMICs but introduced 28% manual entry errors. Adebayo et al. (2021)
designed a USSD menu for Nigerian patients with 65% accuracy, though it lacked real-time
alerts. In Brazil, Silva et al. (2020) incorporated community health worker inputs via GPS,
reducing severe events by 31% in favelas, but this model depends on unavailable infrastructure.
Only Kenya’s DiabTrack (2023) included limited Swahili dietary terms, still missing major
Nigerian foods. Importantly, none addressed academic stress patterns prevalent in universities
(FUTO Medical Records, 2023).

2.3.3 Web Based Systems (7 studies).

Web platforms show the most promise for Nigerians and other developing African countries.
Adeoye et al. (2022)’s Django system in Nigeria achieved ₦2,000/month cost with offline data
sync, though it lacked AI predictions. Uganda’s Chen et al. (2023) built a React-Random Forest
hybrid with 85% offline accuracy, compatible with 2G networks. Ethiopia’s Keneni et al. (2021)
demonstrated 79% clinic integration using PHP, but poor mobile optimization limited student
use. India’s DIABWeb (2024) reduced costs by 60% through progressive web apps, though its
meal tracker ignored local diets. Notably, Ghana’s GlucoCare (2022) combined SMS with basic
ML (81% adoption), but accuracy fell to 65%. The sole study incorporating Nigerian student
data was OAU’s 2023
pilot using Flask (78% accuracy), yet it required continuous internet. This review highlights a
critical void: no web system combines KNN’s sparse-data accuracy with Django’s affordability
and offline resilience.

2.4 Summary of Literature Review

The table below gives a comprehensive summary of the reviewed Literature.
Table 2.3: Summary of Literature Review

S/No Author Purpose/Title Major Findings Limitations/gaps

(year)

1 Li et al. CGM-LSTM 94% accuracy in clinical ₦80k/month cost

(2022) hypoglycemia trials requires continuous
prediction power

2 Osei et al. Smart ring for Type 88% accuracy in African Fails during power
(2023) 2 diabetes detection cohort outages (>4 hours)

3 EMA Non-invasive sweat 91% accuracy; FDA- Daily calibration

 (2023) glucose sensor approved impractical for
students

4 Kumar et Smartwatch PPG + 89% detection rate Requires 5G

al. (2021) CNN for connectivity
hyperglycemia

5 Van der Low-cost IoT glucose 30% cheaper than Still costs ₦45k/month
Merwe patch (South Africa) commercial CGMs
(2024)

6 Park et al. AI-powered insulin Reduced severe events by Needs specialized

(2020) pump system 41% medical supervision

7 SVM-based meal 89% carb estimation No African food

Patel et al. photo analysis accuracy database
(2022)

8 WHO SMS-based glucose 73% adherence rate 28% manual entry

(2023) logging for LMICs errors

9 Adebayo et USSD menu for Works on basic phones No real-time alerts

al. (2021) Nigerian patients (65% accuracy)

10 Silva et al. GPS + community 31% reduction in severe events Unreliable

(2020 health worker system without CHW
networks

11 Gluco-Easy Voice-logging 40% fewer input errors Mandarin language

(2024) diabetes app support only

12 DiabTrack Swahili-enabled 68% accuracy for East Missing Nigerian

(2023) meal tracker African diets staple foods

13 Mburu et al. Mobile AI coach for Improved adherence by Requires 4G

(2022) Type 1 diabetes 22% connectivity

14 Adeoye et Django analytics ₦2k/month cost; offline No predictive AI

al. (2022) dashboard sync

15 Chen et al. React + Random 85% offline accuracy Limited to Type 2

(2023) Forest hybrid diabetes
 16 Keneni et al. PHP-based clinic 79% clinician adoption Poor mobile interface
(2021) integration

17 DIABWeb Progressive web app 60% cost reduction No local diet support
(2024) for diabetes

18 GlucoCare SMS + basic ML 81% adoption rate 65% prediction

(2022) system (Ghana) accuracy

19 OAU Pilot Flask-based student 78% accuracy Requires continuous

(2023) portal internet

20 IDF (2023) Global CGM 62% reduction in Only viable in high-

adoption study hypoglycemia events income countries

2.4.1 Gaps Identified from Literature Review

From the summary of literatures, the following gaps where identified which this study intends to
solve.
(i) Cost Barriers: 12/20 studies had solutions costing >₦20k/month
(ii) Localization Issues: 18/20 lacked Nigerian food databases and 20/20 lacks academic stress
conditions.
(iii) Infrastructure Dependence: 15/20 required stable power and 5G connection.
(iv) Comparative study: None of the studies compared more than 4 algorithms, to understand
how different classification algorithms works and verify the best for diabetes diagnosis
(v) Accuracy: Only very few studies achieved an accuracy of 89%. This study also aims to
achieve an accuracy of more than 89%.
 CHAPTER THREE

METHODOLOGY

3.1 Methodology Adopted: Design-Based Research Framework

Design based Research (DBR) can be defined as an iterative research methodology that
implements practical solutions using systematical design, implementation and evaluation cycle
(Anderson, 2022). These approaches make’s DBR an ideal methodological approach for this
study. DBR follows 6 basic processes which are problem identification, design a solution
(prototype), implement and test, Evaluate, generalize findings and finally provide data feedback.

Figure 3.1: DBR processes

DBR was selected over other methodologies because of its’s approach to handling real word
problems. Firstly, literatures on diabetes and AI were reviewed which lead to identifications of
limitations in the existing system thus leading us to the topic of this project (Problem
identification), Next extensive studies on papers relating to this problem was carried out, next
was developing and testing 5 models to identify and optimize the best to improve accuracy, we
tested the system the evaluate performance and the solutions were now generalize for Nigeria
and Africa context.

3.2 System Analysis of the Existing System

3.2.1 System Architecture
The existing system studied (DiabPredict AI), is a contemporary approach to diabetes diagnosis
using machine learning. Developed as a cloud-based solution, the system processes and analyzes
major clinical parameters including age, BMI, fasting glucose levels and HbA1c percentages
using a single Gradient Boosting Machine (GBM) algorithm. Deployed as a web API interface, it
generates classification diagnostic (diabetic/non-diabetic) that are delivered to medical
practitioners via automated email reports.
Achieving an accuracy of 87.6% on the PIMA Indian diabetes dataset which is good the system
reveals limitations when deployed in resource constrained environments like Nigeria.

Patient entry
(Web form)

Cloud API

GBM Model

Binary Diagnosis

Email Report
Figure 3.2: Core components of Existing System
Operational Process
Data Input
Up to 8 clinical input parameters: Age, BMI, fasting glucose, HbA1c, blood pressure, pregnancy
status (binary), smoker status (binary), physical activity level (low/medium/high)

Cloud Processing
Data forwarded to AWS cloud servers
Model/Algorithm Inference
Single Gradient Boosting Machine (GBM) with fixed hyperparameters
Output: Binary classification (Diabetic/Non-Diabetic)
Reporting System
Automated email with PDF report (no probability scores)
3.2.2 Algorithm Implementation
Model Specifications
Algorithm: The existing system utilizes Gradient Boosting Machine (XGBoost implementation)
Training Data: PIMA Indian Diabetes Dataset (768 samples)
Validation: 80-20 split (no cross-validation)
Key Limitations of this specification
Algorithmic Monoculture
The system Exclusively relies on GBM violating the No Free Lunch Theorem
There is no testing of alternative models (e.g., SVM, RF) despite varying data characteristics
Hyperparameter Inflexibility
Parameters are manually set without optimization
Limited search space exploration (<5% of possible combinations)
Data Source
This existing system was trained exclusively on the PIMA dataset (Indian population) thereby
failing to generalize to African Phenotypes.
3.2.4 Deployment Architecture
Technical Stack
Table 3.1: Existing system deployment architecture

Component Technology used

Frontend React SPA

Backend Flask API

Compute AWS t3xlarge

Storage S3 Buckets

Security Basic Auth

The existing system used native development by implementing Flask API for the web
deployment.
But there were still major constraints like it requires uninterrupted connectivity which is
basically not available in all areas most developing countries, latency issues and hardware
compatibility.
3.2.5 Validation and performance of existing system
The tables below explains the performance of the existing system and why it cannot be
generalized and used in the African countries.
Table 3.2: Performance of Existing system on the PIMA data set

Metric Value Test conditions

Accuracy 87.6% PIMA test set

Recall 82.3% PIMA test set

AUC 0.89% PIMA test set

Metric Value Cause of degradtion

Accuracy 78.4% Phenotypic variation

Recall 74.1% Feature incompleteness

3.3 Proposed System Design
3.3.1 System Architecture Overview
The proposed system for this study follows three stage architecture designed for public
accessibility and clinical reliability. As illustrated in the workflow below, the system begins with
user input through an intuitive Django-based web interface, where individuals enter essential
health parameters including age, BMI, fasting glucose levels, HbA1c percentage, and family
history score. The preprocessed data then goes through the optimized machine learning engine -

tuning. This model outputs a probability score (p ∈ [0,1]), which is converted into a definitive
a single classification model selected through rigorous comparative analysis and hyperparameter

binary diagnosis:
Diabetic (p ≥ 0.5)
Non-Diabetic (p < 0.5)
Results are displayed with a confidence percentage and actionable health recommendations. For
borderline cases (0.45 ≤ p ≤ 0.55), the system explicitly recommends professional medical
consultation while providing clinic location assistance.
Figure 3.3: Flowchart diagram showing proposed system Architecture

3.3.2 Model Development Process

The model development follows a rigorous two-phase methodology to ensure optimal diagnostic
accuracy. In Phase 1, five classification algorithms (K-Nearest Neighbors, Support Vector
Machine, Random Forest, Logistic Regression, and Decision Tree) undergo comparative
evaluation using stratified 5-fold cross-validation on the preprocessed Nigerian diabetes dataset.
Each model is trained on 80% of the data and evaluated against 20% test data using recall-
focused metrics, with performance recorded in a comprehensive evaluation matrix.
The best-performing model is selected based on achieving the highest weighted score (Recall ×
0.6 + Accuracy × 0.4) to prioritize sensitivity while maintaining overall correctness. In Phase 2,
the chosen model undergoes Bayesian hyperparameter optimization using Gaussian Process
regression, conducting 50 iterations of targeted parameter space exploration to maximize
diagnostic precision. The final optimized model is serialized as a .pkl file for seamless Django
integration, completing the development cycle before deployment.

Figure 3.4: Flow chart showing model selection phase

Important Implementation Details:

Stratified Splitting: Preserves original class distribution in splits
Recall-Weighted Selection: Ensures >90% sensitivity target
Parameter Space Design:
KNN: `n_neighbors` (3-15), `weights` (uniform, distance)
SVM: `C` (0.1-10), `gamma` (0.001-0.1)
Random Forest: `n_estimators` (100-500), `max_depth` (3-15)
Convergence Criteria: Optimization stops when EI improvement <0.001 for 5 consecutive
iterations
3.3.3 Key Component Specifications
The proposed system is made up of four essential technical components that collectively enable
accurate diabetes diagnosis. Each component is designed for reproducibility and clinical
reliability:
Data Preprocessing Engine
Function: Transforms raw user inputs into ML-ready features
Operations:
Nigerian value range validation (e.g., HbA1c: 4.0-15.0%)
Family history quantification (0-5 scale based on affected relatives)
Algorithms: Scikit-learn's StandardScaler with custom range constraints

Model Comparison Module

Function: Evaluates 5 algorithms/model to identify optimal baseline

Implementation sample:
from sklearn.model_selection import cross_validate
models = [KNN(), SVM(), RF(), LR(), DT()]
results = {}
for model in models:
cv_results = cross_validate(
model, X_train, y_train,
cv=5,
scoring=['accuracy', 'recall', 'precision']
)
results[model.__class__.__name__] = {
'accuracy': cv_results['test_accuracy'].mean(),
'recall': cv_results['test_recall'].mean()
 }
# Select model with highest recall while accuracy >85%
best_model = max(models, key=lambda m: results[m]['recall']
if results[m]['accuracy'] > 0.85 else 0)

Bayesian Optimization Core

Function: Enhances selected model's accuracy
Mathematical Basis: Gaussian Process Regression
Model improvement <0.001 for 10 consecutive iterations
Django Integration
Function: Integrates ML model with user interface
Key Elements:
# views.py (simplified)
def predict_diabetes(request):
if request.method == 'POST':
form = DiabetesForm(request.POST)
if form.is_valid():
# Extract and preprocess
features = [
form.cleaned_data['age'],
form.cleaned_data['bmi'
]
scaled_features = preprocessor.transform([features])
# Predict
probability = optimized_model.predict_proba(scaled_features)[0][1]
diagnosis = "Diabetic" if probability >= 0.5 else "Non-Diabetic"
# Borderline check
 borderline = 0.45 <= probability <= 0.55
return render(request, 'result.html', {
'diagnosis': diagnosis,
'borderline': borderline,
'confidence': round(max(probability, 1-probability)*100, 1)
})

3.3.4 User Interface Workflow

The interface follows a sequential three-step process optimized for ease use:

Key Interface Features

Input: Use of HTML form to collect input informations like (BMI , fasting gluyetc,.).
Result Clarity:
Color-coded diagnosis (Red: Diabetic, Green: Non-Diabetic)
Large font classification
Health Guidance:
Immediate dietary/exercise recommendations
Emergency contact for high-risk results
Figure 3.5: Flowchart for showing interface workflow.

3.4 Tools and Technology to be used in designing Proposed System

The implementation employs a purpose-built technology stack optimized for medical AI
development in resource-conscious environments. All tools are open-source and widely adopted
in both academic and industrial settings.

Machine Learning Development Tools

Python 3.11 is the foundational programming language due to its extensive use in Data Science
projects. Scikit-learn (v1.3) provides the core classification algorithms (KNN, SVM, RF, LR,
DT) and evaluation metrics. Bayesian hyperparameter optimization is implemented using
BayesianOptimization (v1.4.3) with Gaussian Process regression. Class imbalance is addressed
through Imbalanced-learn's (v0.10) constrained SMOTE implementation, while Pandas (v2.0)
and NumPy (v1.24) handle dataset manipulation.
Web Development Tools
Django (v4.2) forms the web framework backbone with Django REST Framework (v3.14)
managing API endpoints. Bootstrap (v5.3) enables responsive frontend design accessible on low-
bandwidth networks, while Plotly.js (v2.24) generates interactive visualizations for model
explainability. User authentication and data security are implemented by Django-Allauth (v0.57)
and Django Cryptography (v1.0).
Validation and Testing Tools
The performance of each model is evaluated using Scikit-learn's cross_val_score with 5-fold
stratified sampling.
The tools and technologies listed above were used based on the following important factors
Zero licensing costs, compatibility with low specification hardware, extensive documentation
and community support, medical compliances (data anonymization, audit trails).
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