Predicting 10-Year Risk of End-Organ Complications of Type 2 Diabetes With and Without Metabolic Surgery: A Machine Learning Approach
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OBJECTIVE: To construct and internally validate prediction models to estimate the risk of long-term end-organ complications and mortality in patients with type 2 diabetes and obesity that can be used to inform treatment decisions for patients and practitioners who are considering metabolic surgery. RESEARCH DESIGN AND METHODS: A total of 2,287 patients with type 2 diabetes who underwent metabolic surgery between 1998 and 2017 in the Cleveland Clinic Health System were propensity-matched 1:5 to 11,435 nonsurgical patients with BMI ≥30 kg/m2 and type 2 diabetes who received usual care with follow-up through December 2018. Multivariable time-to-event regression and random forest machine learning models were built and internally validated using fivefold cross-validation to predict the 10-year risk for four outcomes of interest. The prediction models were programmed to construct user-friendly web-based and smartphone applications of Individualized Diabetes Complications (IDC) Risk Scores for clinical use. RESULTS: The prediction tools demonstrated the following discrimination ability based on the area under the receiver operating characteristic curve (1 = perfect discrimination and 0.5 = chance) at 10 years in the surgical and nonsurgical groups, respectively: all-cause mortality (0.79 and 0.81), coronary artery events (0.66 and 0.67), heart failure (0.73 and 0.75), and nephropathy (0.73 and 0.76). When a patient’s data are entered into the IDC application, it estimates the individualized 10-year morbidity and mortality risks with and without undergoing metabolic surgery. CONCLUSIONS: The IDC Risk Scores can provide personalized evidence-based risk information for patients with type 2 diabetes and obesity about future cardiovascular outcomes and mortality with and without metabolic surgery based on their current status of obesity, diabetes, and related cardiometabolic conditions.
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Aminian et al. (2020) found that cardiovascular events are among the most frequent complications in patients with type 2 diabetes and obesity.
“They found that cardiovascular events are among the most frequent complications in patients with type 2 diabetes and obesity.”
From Artificial intelligence based prediction models for individuals at risk of multiple diabetic complications: A systematic review of the literature (2022) · cites this paper as Aminian et al. (2020)
The Introduction (page unavailable) identifies cardiovascular outcomes as important complications in patients with type 2 diabetes and obesity, and its baseline-characteristics table reports coronary artery disease and heart failure in roughly 10% of the study groups. The paper does not establish that cardiovascular events, as a group, are among the most frequent complications; that frequency ranking goes beyond what these passages show. (LLM, conf=0.80)
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- Authors
- Aminian, A., Zajichek, A., Arterburn, D. E., Wolski, K. E., Brethauer, S. A., Schauer, P. R., Nissen, S. E., & Kattan, M. W.
- Affiliations
- Cleveland Clinic (US)
- Kaiser Permanente Washington Health Research Institute (US)
- Pennington Biomedical Research Center (US)
- Corresponding author
- Aminian, Ali
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2020-02-06
- Volume
- 43
- Issue
- 4
- Pages
- 852-859
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC7646205
- OpenAlex
- W3004712038
- Cited by
- 99
- References
- 33
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 10 · 2023: 29 · 2022: 19 · 2021: 17 · 2020: 7
- FWCI
- 16.45
- Type
- journal article
- Language
- en
- Update notices
- correction (2020-06-01)
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medtronic
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 2 diabetes, metabolic surgery, obesity, end-organ complications, 10-year risk prediction, all-cause mortality, coronary artery disease, heart failure, diabetic nephropathy, risk prediction model, mobile health apps, cardiovascular outcomes
- MeSH terms
- Machine Learning, Adolescent, Adult, Aged, Aged, 80 and over, Computer Simulation, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Time Factors, Disease Progression, Diabetes Complications, Bariatric Surgery, Young Adult, Organs at Risk
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