New Calculator Predicts Risk Of Death And Complications From Diabetes And Obesity

Researchers at the Cleveland Clinic, whose cardiology program has been ranked No. 1 in the United States since 1995, have developed an easy-to-use, web-based risk calculator that can accurately predict the likelihood of a patient with type 2 diabetes and obesity to die or develop serious complications from these conditions within the next 10 years.

These complications include a heart attack, heart failure and diabetic kidney disease (nephropathy), depending on whether a patient has metabolic (bariatric) surgery or continues with standard medical treatment.

This new life-saving tool is called the Individualized Diabetes Complication (IDC) Risk Calculator. The IDC Risk Calculator is available at the Cleveland Clinic Risk Calculator Library. It can also be downloaded as an app for Android and iOS (BariatricCalc).

Its features are detailed in a new study presented Tuesday by Cleveland Clinic researchers at the 36th American Society for Metabolic and Bariatric Surgery (ASMBS) Annual Meeting at ObesityWeek 2019.

Significant evidence has been accumulated over the past two decades, showing surgery can cure or improve several metabolic diseases, especially adult onset or Type 2 diabetes mellitus. These findings followed the publication in 1995 of a landmark paper by Dr. Walter Pories and his research team that proves an operation might be the most effective therapy for adult-onset diabetes mellitus.

Since then, a large number of studies have shown that metabolic surgery procedures such as sleeve gastrectomy and gastric bypass are superior to medical therapy in improving type 2 diabetes and in lowering the risk of heart attacks, strokes and other major adverse cardiovascular events for most patients with obesity.

A recent study in the Journal of the American Medical Association by researchers at the Cleveland Clinic reveals patients that had metabolic surgery were 39 percent less likely to experience a heart-, stroke-, or diabetic kidney-related complication and 41 percent were less likely to die from any cause.

This study compared the outcomes of 13,722 patients with type 2 diabetes and obesity. Of this total, 2,287 were metabolic surgery patients and 11,435 closely matched patients eligible for surgery but received standard medical therapy.

Cleveland Clinic researchers took this data and in a new study identified the factors contributing to four potential adverse diabetes outcomes -- death, cardiovascular event, heart failure and diabetic kidney disease.

The new IDC Risk Calculator uses rigorous statistical analysis and machine learning, accurate prediction models. The risk calculation is based on a combination of variables. These include the patient's age, medical history, diabetes control, body mass index and medication usage.

The outcome of this calculation is a 10-year personalized risk score if a patient continues his current treatment or undergoes metabolic surgery.

"The IDC Risk Calculator can provide a glimpse into the future for individuals with diabetes and obesity, and demonstrate the impact usual medical care versus metabolic surgery would have on their risk of death or major complications," Dr. Ali Aminian, lead study author, MD, FACS, FASMBS, a bariatric surgeon and associate professor of surgery at the Cleveland Clinic, OH, said.

"This can better inform treatment decisions and doctor recommendations and hopefully lead to improved patient care and outcomes."