{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:31:04Z","timestamp":1787502664518,"version":"build-2736575974"},"reference-count":38,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100004339","name":"Sanofi","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004339","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Despite the proven efficacy of GLP\u20101 receptor agonists (GLP\u20101 RAs), many patients with type 2 diabetes (T2DM) are not able to achieve glycaemic targets with these agents and they require additional therapies. Timely identification of individuals at higher risk of early intensification may improve outcomes and reduce therapeutic inertia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>In this retrospective cohort study, we analysed data from 69\u2009194 individuals with T2DM initiating GLP\u20101 RA. We applied logic learning machine (LLM), an explainable machine\u2010learning algorithm, to identify\u2014at the time of GLP\u20101 RA prescription\u2014predictors of early intensification (\u2264\u200912\u2009months from GLP\u20101 RA initiation). For this purpose, we developed two distinct models: Model 1, which compared characteristics of individuals intensified early (\u2264\u200912\u2009months) versus those not intensified in the first year, and Model 2, comparing individuals intensified early vs. those never intensified (&gt;\u20095\u2009years of GLP\u20101 RA treatment).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both models identified the same clinical phenotype, characterised by longer diabetes duration, unstable glycaemic control, prior insulin use, and cardio\u2010renal complications. Model 1 showed limited discriminative ability (AUC 0.65) with many false positives, suggesting therapeutic inertia in real\u2010world practice. Model 2, while selecting same predictors of Model 1, achieved better performance (AUC 0.78), suggesting clearer differentiation between patient cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Explainable AI identified a reproducible phenotype of patients associated with early intensification after GLP\u20101 RA initiation. These models may support earlier, more personalised treatment decisions in routine diabetes care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70648","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T06:47:18Z","timestamp":1773125238000},"page":"4718-4727","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Identifying Predictors of Early Treatment Intensification in Individuals With Type 2 Diabetes Treated With\n                    <scp>GLP<\/scp>\n                    \u20101 Receptor Agonists: A Machine Learning\u2013Based Analysis of a Large Real World Cohort"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3182-0453","authenticated-orcid":false,"given":"Pierpaolo","family":"Falcetta","sequence":"first","affiliation":[{"name":"Diabetes Unit, Azienda USL Toscana Centro  Empoli Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Zilich","sequence":"additional","affiliation":[{"name":"Mix\u2010X Partner  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Baccetti","sequence":"additional","affiliation":[{"name":"Diabetes Unit, ASL Toscana Nord\u2010Ovest  Massa\u2010Carrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Baronti","sequence":"additional","affiliation":[{"name":"Diabetes Unit, ASL Toscana Sud\u2010Est  Grosseto Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lelio","family":"Morviducci","sequence":"additional","affiliation":[{"name":"UOC Diabetologia e Dietologia, Ospedale S. Spirito \u2010 ASL Roma 1  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoletta","family":"Musacchio","sequence":"additional","affiliation":[{"name":"UOS Integrating Primary and Specialist Care, ASST Nord Milano  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Muselli","sequence":"additional","affiliation":[{"name":"Rulex Innovation Labs Rulex Inc  Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Ozzello","sequence":"additional","affiliation":[{"name":"AI\u2010AMD National Group  Bruino Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Pisani","sequence":"additional","affiliation":[{"name":"Mix\u2010X Partner  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Rossi","sequence":"additional","affiliation":[{"name":"I.R.C.C.S. 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