Diabetes calculator weighs risk of bariatric surgery against standard care

A novel risk calculator developed by researchers at the Cleveland Clinic encourages patients with both type 2 diabetes and obesity to weigh their treatment options for optimal long-term health.

Bariatric surgery, or weight loss surgery, has been recommended as a treatment option for people with concomitant type 2 diabetes mellitus and obesity since 2016, when the American Diabetes Association first published a consensus report on the subject. But the therapy remains underutilized in clinical practice, eclipsed largely by standard medical care and lifestyle advice.

Bariatric surgeon Ali Aminian, MD, and colleagues at the Cleveland Clinic developed their new tool—the 10-year Individualized Diabetes Complications Risk Scores—in two phases over the course of two years, focusing on individualized recommendations based on patients’ current health status and evidence-based data. The first phase, which wrapped earlier this year and was published in JAMA in September, found that weight loss surgery in patients with type 2 diabetes and obesity was linked to a 40% lower risk of death and major adverse CV events in the decade following. Those patients also had better diabetes control, lost more weight and used fewer medications than their peers.

The same group of patients were used in phase two of the trial, which aimed to identify predictors for different health outcomes. Aminian and his team studied 26 unique risk factors for different outcomes, including risk of dying, and developed their risk calculator to estimate the likelihood of coronary heart disease, stroke, heart failure, kidney disease and mortality over 10 years.

“The calculator can be a useful tool for physicians and patients with type 2 diabetes and obesity,” Aminian said in a release. “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. It also shows how a patient’s risk of those adverse events could change after metabolic surgery.”

Aminian et al.’s results are being presented this week at the ObesityWeek 2019 international symposium in Las Vegas. The calculator will be accessible via the Cleveland Clinic Risk Calculator Library and as a smartphone application, BariatricCalc.

“Diabetes can be a devastating disease and combined with obesity, patients are at a high risk for cardiovascular complications,” Steven Nissen, MD, chief academic officer of the Heart & Vascular Institute at Cleveland Clinic, said in the release. “Metabolic surgery is an underutilized treatment for these patients. This calculator can help both physicians and patients quantify the risks and benefits of surgery and make the best decision for treatment.”