Research News

Patients struggling with type 2 diabetes and obesity are faced with the decision of whether to receive usual medical care or undergo weight-loss surgery. Now, a new risk calculator developed by a team of Cleveland Clinic researchers can show these patients their risks of developing major health complications over the next 10 years depending on which course of treatment they choose.

To help patients and their physicians better predict the health benefits of usual care versus surgical treatment, Ali Aminian, MD, Digestive Disease & Surgery Institute, collaborators Michael Kattan, PhD, Lerner Research Institute, and Steven Nissen, MD, Miller Heart & Vascular Institute, developed a risk score calculator that provides personalized, evidence-based information based on a patient’s current health status.

The calculator — 10-year Individualized Diabetes Complications Risk Scores — was developed in two phases over the course of about two years. In the first phase, an observational study looked at nearly 2,300 patients who underwent metabolic surgery and 11,500 matched patients with similar characteristics who received usual medical care.

The phase 1 results, published in the Journal of the American Medical Association (JAMA) in September, show that weight-loss surgery performed in patients with type 2 diabetes and obesity is associated with 40 percent lower risk of death and major adverse cardiovascular events than usual medical care. Surgical patients also lost more weight, had better diabetes control, and used fewer medications for treatment of their diabetes and cardiovascular disease than those undergoing usual medical care.

In phase 2, the researchers used the same group of patients to identify predictors for different health outcomes. Evidence-based models were built and integrated into a risk calculator to estimate the likelihood of coronary heart disease, stroke, heart failure, diabetic kidney disease, and mortality over the next 10 years in patients with type 2 diabetes and obesity with and without bariatric surgery

“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,” said Dr. Kattan. “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.”

The calculator will be accessible on the Cleveland Clinic Risk Calculator Library website and as a smartphone application (BariatricCalc).

Story adapted from Cleveland Clinic Newsroom