Predicting Diabetic Retinopathy Using Saudi Insurance Claims Data—Development and Validation of a Real-Time Risk Stratification System

Introduction and Objective: Diabetic retinopathy (DR) is a leading cause of visual impairment and can be prevented with early detection. While most predictive models use electronic health records (EHRs), their accessibility and scalability can be limited. This study aims to develop and validate a real-time risk stratification system for DR using Saudi insurance claims data, an underutilized resource in predictive health analytics. Methods: A retrospective cohort with Type 2 diabetes, insured by MEDGULF, was analyzed using claims data from July 2022 to July 2024. The observation period (July 2022-July 2023) was used to train the system, and the prediction period (July 2023-July 2024) was reserved for validation. Key input features included ICD-10 diagnosis codes, unstructured clinical notes on reason of visit and chief complaint and demographic and healthcare utilization data. The system’s performance was evaluated using AUROC and sensitivity at a fixed threshold of 80%, with calibration assessed for robustness. Results: The system achieved an AUROC of 0.720 (95% CI: 0.708-0.736) on a validation set of 7,410 patients, demonstrating reliable discrimination and solid performance in identifying high-risk patients. Stratification into risk categories allowed for targeted interventions, ensuring timely management of patients at risk of DR. Conclusion: This real-time system demonstrates the feasibility and clinical utility of using Saudi insurance claims data for DR risk prediction, offering a scalable solution with strong potential for reducing diabetic complications. Future work will include prospective validation and integration into clinical care pathways to optimize patient outcomes. Disclosure: G. Ghosheh: Employee; iO Health. M. Ghosheh: Employee; iO Health. W. Afzal: Employee; MEDGULF Insurance & Reinsurance Company. M.A. Mohamed: Employee; MEDGULF Insurance & Reinsurance Company. A. Kheir: Employee; MEDGULF Insurance & Reinsurance company.