{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T13:42:07Z","timestamp":1777902127158,"version":"3.51.4"},"reference-count":63,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Science Progress"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>In older adults with Type 2 diabetes mellitus (T2DM), the risk of delirium is significantly increased, driven by neuropathological alterations stemming from chronic insulin resistance. We utilized artificial intelligence and geriatric electronic health records to create an interpretable online machine-learning algorithm for predicting delirium risk. This tool facilitates prompt identification of high-risk elderly T2DM patients, enabling optimized interventions and improved clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study identified older adults with T2DM using International Classification of Diseases (ICD) codes, with delirium defined by the Confusion Assessment Method for the intensive care unit (CAM-ICU). We extracted baseline demographics, vital signs, laboratory measurements, comorbidities and clinical severity scores. Candidate predictors for eight machine-learning algorithms were selected using least absolute shrinkage and selection operator regression and the Boruta method. Discrimination was assessed using accuracy, sensitivity, specificity and the F1 score. The final model was interpreted using SHapley Additive exPlanations (SHAP) and deployed as an online risk calculator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Integrating dual feature selection methods identified 14 key predictors and the gradient boosting machine (GBM) model accurately predicted delirium risk in elderly patients with T2DM, demonstrating strong discriminatory performance with robust calibration in both internal and external validation. SHAP analysis highlighted the Glasgow Coma Scale, ICU length of stay and Sequential Organ Failure Assessment score as the predominant contributors to model predictions. The model was successfully deployed as an accessible online tool and the accompanying web-based calculator enables rapid, personalized risk assessment to support early intervention in ICU settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The GBM model showed strong performance in predicting delirium risk among elderly patients with T2DM, supporting clinically meaningful risk stratification. The accompanying web-based calculator enables rapid, individualized bedside assessment and may facilitate early identification of high-risk patients and timely intervention in ICU settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00368504261436075","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T12:41:51Z","timestamp":1774356111000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of an online machine-learning tool for predicting delirium risk in older adults with type 2 diabetes: A retrospective cohort study based on the MIMIC-IV database"],"prefix":"10.1177","volume":"109","author":[{"given":"Lang","family":"Gao","sequence":"first","affiliation":[{"name":"Clinical Medical College of Qinghai University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7237-3517","authenticated-orcid":false,"given":"Guangdong","family":"Wang","sequence":"additional","affiliation":[{"name":"First Affiliated Hospital of Xi\u2019an Jiaotong University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7280-4820","authenticated-orcid":false,"given":"Xingyi","family":"Yang","sequence":"additional","affiliation":[{"name":"XianJu People\u2019s Hospital, Zhejiang Southeast Campus of Zhejiang Provincial People's Hospital, Affiliated Xianju's Hospital, Hang Zhou Medical College"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanshuo","family":"Ge","sequence":"additional","affiliation":[{"name":"Jinzhou Medical University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shijun","family":"Tong","sequence":"additional","affiliation":[{"name":"Clinical Medical College of Qinghai University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xia","family":"Xiang","sequence":"additional","affiliation":[{"name":"The First People's Hospital of Foshan, School of Medicine, Southern University of Science and Technology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunyan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of International Medical Center, The First People's Hospital of Foshan (Foshan Hospital Affiliated to Southern University of Science and Technology), School of Medicine, Southern University of Science and Technology, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2342-9843","authenticated-orcid":false,"given":"Yun","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of International Medical Center, The First People's Hospital of Foshan (Foshan Hospital Affiliated to Southern University of Science and Technology), School of Medicine, Southern University of Science and Technology, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"e_1_3_4_2_2","article-title":"Platelet glycoprotein-Ib (GPIb) may serve as a bridge between type 2 diabetes mellitus (T2DM) and atherosclerosis, making it a potential target for antiplatelet agents in T2DM patients","volume":"13","author":"Amalia M","year":"2023","unstructured":"Amalia M, Puteri MU, Saputri FC, et al. Platelet glycoprotein-Ib (GPIb) may serve as a bridge between type 2 diabetes mellitus (T2DM) and atherosclerosis, making it a potential target for antiplatelet agents in T2DM patients. Life (Basel) 2023; 13: 1473.","journal-title":"Life (Basel)"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S290639"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0273327"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2024.2405072"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2018.18070893"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/147323000703500511"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12035-015-9667-3"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.12807"},{"key":"e_1_3_4_10_2","article-title":"Confusion assessment method for the intensive care unit (CAM-ICU) for the diagnosis of delirium in adults in critical care settings","volume":"11","author":"Miranda F","year":"2023","unstructured":"Miranda F, Gonzalez F, Plana MN, et al. Confusion assessment method for the intensive care unit (CAM-ICU) for the diagnosis of delirium in adults in critical care settings. Cochrane Database Syst Rev 2023; 11: CD013126.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0242378"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.17344\/acsi.2023.8216"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-05137-3"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccc.2023.02.001"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2018.08.073"},{"key":"e_1_3_4_16_2","first-page":"125","article-title":"A pipeline-based framework for early prediction of diabetes","volume":"10","author":"Abnoosian K","year":"2023","unstructured":"Abnoosian K, Farnoosh R, Behzadi MH. A pipeline-based framework for early prediction of diabetes. J Health Biomed Inf 2023; 10: 125\u2013140.","journal-title":"J Health Biomed Inf"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-024-02902-1"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2212850"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.70176\/3007-973X.1012"},{"key":"e_1_3_4_20_2","article-title":"Solid lipid nanocarriers for drug delivery: design innovations and characterization strategies\u2014a comprehensive review","volume":"6","author":"Bukke SPN","year":"2024","unstructured":"Bukke SPN, Venkatesh C, Bandenahalli Rajanna S, et al. Solid lipid nanocarriers for drug delivery: design innovations and characterization strategies\u2014a comprehensive review. Discover Appl Sci 2024; 6: 279.","journal-title":"Discover Appl Sci"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.4143\/crt.2020.974"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.901602"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2019.3671"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12859-023-05465-z"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2656.2008.01390.x"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnbot.2013.00021"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60688-1"},{"key":"e_1_3_4_29_2","first-page":"30","article-title":"Delirium and psychotic symptoms associated with hyperglycemia in a patient with poorly controlled type 2 diabetes mellitus","volume":"15","author":"Lopes R","year":"2018","unstructured":"Lopes R, Pereira BD. Delirium and psychotic symptoms associated with hyperglycemia in a patient with poorly controlled type 2 diabetes mellitus. Innov Clin Neurosci 2018; 15: 30\u201333.","journal-title":"Innov Clin Neurosci"},{"key":"e_1_3_4_30_2","article-title":"Delirium and long term cognition in critically ill patients","volume":"373","author":"Wilcox ME","year":"2021","unstructured":"Wilcox ME, Girard TD, Hough CL. Delirium and long term cognition in critically ill patients. Br Med J 2021; 373: n1007.","journal-title":"Br Med J"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc11407"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-020-00938-y"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-007-0920-8"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0051010"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.aucc.2023.05.007"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-31234-4"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13198-024-02354-3"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.4103\/jmss.jmss_29_24"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0330454"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-023-04768-y"},{"key":"e_1_3_4_41_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-024-02762-w"},{"key":"e_1_3_4_42_2","doi-asserted-by":"publisher","DOI":"10.1080\/0886022X.2025.2514186"},{"key":"e_1_3_4_43_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-38650-4"},{"key":"e_1_3_4_44_2","doi-asserted-by":"publisher","DOI":"10.1111\/cns.14237"},{"key":"e_1_3_4_45_2","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S398314"},{"key":"e_1_3_4_46_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2024.1399848"},{"key":"e_1_3_4_47_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-022-04131-9"},{"key":"e_1_3_4_48_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-023-02282-5"},{"key":"e_1_3_4_49_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(19970228)16:4<385::AID-SIM380>3.0.CO;2-3"},{"key":"e_1_3_4_50_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-40036-5"},{"key":"e_1_3_4_51_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2023.104565"},{"key":"e_1_3_4_52_2","article-title":"Development and validation of risk-stratification delirium prediction model for critically ill patients: a prospective, observational, single-center study","volume":"96","author":"Chen Y","year":"2017","unstructured":"Chen Y, Du H, Wei BH, et al. Development and validation of risk-stratification delirium prediction model for critically ill patients: a prospective, observational, single-center study. Medicine (Baltimore) 2017; 96: e7543.","journal-title":"Medicine (Baltimore)"},{"key":"e_1_3_4_53_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afae101"},{"key":"e_1_3_4_54_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2009.24"},{"key":"e_1_3_4_55_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2025.1580125"},{"key":"e_1_3_4_56_2","article-title":"Development of a machine learning-based predictive model for postoperative delirium in older adult intensive care unit patients: retrospective study","volume":"27","author":"Li H","year":"2025","unstructured":"Li H, Zang Q, Li Q, et al. Development of a machine learning-based predictive model for postoperative delirium in older adult intensive care unit patients: retrospective study. J Med Internet Res 2025; 27: e67258.","journal-title":"J Med Internet Res"},{"key":"e_1_3_4_57_2","doi-asserted-by":"publisher","DOI":"10.1093\/bib\/bbae686"},{"key":"e_1_3_4_58_2","doi-asserted-by":"publisher","DOI":"10.1111\/cas.16327"},{"key":"e_1_3_4_59_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2020.103653"},{"key":"e_1_3_4_60_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc9333"},{"key":"e_1_3_4_61_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g7594"},{"key":"e_1_3_4_62_2","doi-asserted-by":"publisher","DOI":"10.7326\/M18-1377"},{"key":"e_1_3_4_63_2","doi-asserted-by":"publisher","DOI":"10.1038\/sdata.2016.35"},{"key":"e_1_3_4_64_2","doi-asserted-by":"publisher","DOI":"10.1038\/sdata.2018.178"}],"container-title":["Science Progress"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00368504261436075","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00368504261436075","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00368504261436075","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T11:20:30Z","timestamp":1777634430000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00368504261436075"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":63,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1177\/00368504261436075"],"URL":"https:\/\/doi.org\/10.1177\/00368504261436075","relation":{},"ISSN":["0036-8504","2047-7163"],"issn-type":[{"value":"0036-8504","type":"print"},{"value":"2047-7163","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"article-number":"00368504261436075"}}