The Impact of the SMOTE Method on Machine Learning and Ensemble Learning Performance Results in Addressing Class Imbalance in Data Used for Predicting Total Testosterone Deficiency in Type 2 Diabetes Patients

Background and Objective: Diabetes Mellitus is a long-term, multifaceted metabolic condition that necessitates ongoing medical management. Hypogonadism is a syndrome that is a clinical and/or biochemical indicator of testosterone deficiency. Cross-sectional studies have reported that 20-80.4 % of all men with Type 2 diabetes have hypogonadism, and Type 2 diabetes is related with low testosterone. This study presents an analysis of the use of ML and EL classifiers in predicting testosterone deficiency. In our study, we compared optimized traditional ML classifiers and three EL classifiers using grid search and stratified k-fold cross-validation. We used the SMOTE method for the class imbalance problem. Methods: This database contains 3397 patients for the assessment of testosterone deficiency. Among these patients, 1886 patients with type 2 diabetes were included in the study. In the data pre-processing stage, firstly outlier/excessive observation analyses were performed LOF and missing value analyses were performed with random forest. The SMOTE is a method for generating synthetic samples of the minority class. Four basic classifiers, namely MLP, RF, ELM and LR, were used as first level classifiers. Tree ensemble classifiers, namely ADA, AGBoost, and SGB, were used as second level classifiers. Results: After SMOTE, while the diagnostic accuracy decreased in all base classifiers except ELM, sensitivity values increased in all classifiers. Similarly, while the specificity values decreased in all classifiers, F1 score increased. The RF classifier gave more successful results on the base-training dataset. The most successful ensemble classifier in the training dataset was the ADA classifier in the original data and in the after SMOTE data. The testing data, XGBoost is the most suitable model for your intended use in evaluating model performance. XGBoost, which exhibits a balanced performance especially when SMOTE is used, can be preferred to correct class imbalance. Conclusions: SMOTE is used to correct the class imbalance in the original data. However, as seen in this study, when SMOTE was applied, the diagnostic accuracy decreased in some models, but the sensitivity increased significantly. This shows the positive effects of SMOTE to better predict the minority class.