For individuals living with type 2 diabetes and obesity, the decision whether to have weight-loss surgery can be stressful, but a new tool has potential to make this process simpler.
Thanks to researchers at the Cleveland Clinic, a new calculator can show these patients their risk of developing major complications over a 10-year period, depending on which treatments they opt for. The calculator offers personalized, evidence-based information based on an individual’s current health status.
Weight-loss surgery can be helpful both at controlling diabetes and improving cardiovascular health, research shows, and in 2016, leading diabetes organizations recommended that metabolic surgery ought to be a treatment option for those with type 2 diabetes and obesity. Yet few eligible patients have the surgery.
As a way to help both patients and their providers more accurately predict the benefits of surgery versus usual care, the team of researchers at the Cleveland Clinic devised the risk score calculator.
“It shows a patient’s risk of heart disease, stroke, heart failure, diabetic kidney disease, and death over the next 10 years with usual care,” explained lead study author Ali Aminian, MD, in a statement. “It also shows how a patient’s risk of those adverse events could change after metabolic surgery.”
The research on the calculator was developed over a two-year period in two phases. The phase 1 results, published in September in the Journal of the American Medical Association, demonstrate that weight-loss surgery in individuals with type 2 diabetes and obesity is linked with a 40 percent lower risk of death and major adverse cardiovascular events, when compared to usual medical care. The phase 1 results also showed that surgery patients had better control of their diabetes, lost more weight, and took fewer medications to treat their diabetes and cardiovascular disease than those who opted for usual medical care.
For phase 2, the researchers focused on the same group of patients in order to come up with predictions for various health outcomes. They set out to estimate the likelihood that the patients with type 2 diabetes and obesity (either with or without bariatric surgery) would develop coronary heart disease, stroke, heart failure, diabetic kidney disease, and mortality over the next 10 years.
“Based on the advice of subject matter experts, our team was able to explore 26 risk factors for the different outcomes, including risk of dying, in that large group of patients,” Michael Kattan, PhD, chairman of the Department of Quantitative Health Sciences in Cleveland Clinic’s Lerner Research Institute, noted. “We then compared machine learning and traditional statistical techniques to identify the most accurate prediction models for each outcome and built those into the calculator.”
Because metabolic surgery is an underutilized treatment for type 2 diabetes, the ultimate goal of the tool is to “quantify the risks and benefits of surgery and make the best decision for treatment,” added Steven Nissen, MD, the Cleveland Clinic’s Chief Academic Officer of the Heart & Vascular Institute.
The calculator is accessible on the Cleveland Clinic Risk Calculator Library website and as a smartphone application, BariatricCalc. The Cleveland Clinic has dozens of other calculators addressing topics such as pregnancy, kidney disease, heart conditions and more.
Cleveland Clinic Develops Calculator to Estimate 10-Year Risk of Diabetes Complications. Cleveland Clinic Newsroom.
Metabolic Surgery for Type 2 Diabetes: Changing the Landscape of Diabetes Care, American Diabetes Association.