Languages:
Step 1

Calculate Risk

Sex
Age
 
Systolic Blood Pressure
 
Race/Ethnicity (if applicable)
Current Medications
Medical History

Labs

Serum creatinine
 umol/L
eGFR (2021 CKD-EPI equation)
85 ml/min/1.73 m²
Urine albumin-creatinine (ACR) ratio
 mg/mmol
Total cholesterol
 mmol/L
HDL cholesterol
 mmol/L
Hemoglobin A1c
 
 

Risk of complications related to diabetes in the next 10 years

Step 2

What Matters Most to You?

What outcome would you like to focus on when discussing your treatment options in Step 3?

Risk of complications related to diabetes in the next 10 years

Step 3

Medication Options

Note: Treatments that have no impact on (or no evidence for) the selected outcome are greyed out.


Glucose-lowering medications
Side effects
14%0.1%
CostAbout $300 for 90 days (or $1200/year). Can prescribe empagliflozin 12.5 mg daily (splitting 25-mg tablets) to cut the cost to ~$150 for 90 days (or $600/year)
RoutineOne pill once a day
CautionMake sure to follow good sick-day management: https://www.rxfiles.ca/rxfiles/uploads/documents/SADMANS-Rx.pdf
OtherDoes not increase the risk of severe hypoglycemia
Side effects
6%
CostAbout $500-900 for 90 days ($1800-3600/year)
RoutineSemaglutide: Available as a tablet (one table once a day) or injection (one injection once a week). Others: Once a day or once a week.
OtherDoes not increase the risk of severe hypoglycemia. Causes weight loss (average ~2 kg; greater if heavier)
Side effects
16%
CostAbout $25 for 90 days ($100/year). May be combined with other diabetes medications in a combination pill
RoutineOne or two pills twice a day
CautionMake sure to follow good sick-day management: https://www.rxfiles.ca/rxfiles/uploads/documents/SADMANS-Rx.pdf
OtherDoes not increase the risk of severe hypoglycemia
Side effects
0.7%0.15%
CostAbout $335 for 90 days ($1400/year)
RoutineOne pill once a day
OtherDoes not increase the risk of severe hypoglycemia
Side effects
0.6%
CostAbout $25-35 for 90 days ($100-140/year)
RoutineOne pill once or twice a day
CautionMake sure to follow good sick-day management: https://www.rxfiles.ca/rxfiles/uploads/documents/SADMANS-Rx.pdf
Side effects
32%4%
CostVaries based on dose
RoutineVaries from one injection once a day to several times per day
CautionCauses weight gain (average ~2 kg). Make sure to follow good sick-day management: https://www.rxfiles.ca/rxfiles/uploads/documents/SADMANS-Rx.pdf
[hide] SBP Difference -> HF Reduction
0.8464
[hide] SBP Difference -> ASCVD Reduction
0.8836
[hide] SBP Difference -> Mortality reduction
0.83
Lipid-lowering medications
Side effects
1%1%0.01%
CostAbout $30 for 90 days ($120/year)
RoutineOne pill once a day
Side effects
  • None
CostAbout $30 for 90 days ($120/year)
RoutineOne pill once a day

Blood pressure target

Side effects
  • Varies based on which medications are used
CostVaries based on which medications are used
RoutineVaries based on which medications are used
Target blood pressure
 
Warning: Current blood pressure is greater than entered target blood pressure - this tool does not estimate the effects of increasing blood pressure.
Other medications
Side effects
5%2%1%0.2%
CostAbout $25 for 90 days ($100/year)
RoutineOne pill once a day
Side effects
1%
CostAbout $40/year
RoutineOne pill once a day
CautionConsider taking with food to minimize stomach upset.
Acetylsalicylic acid disabled as the patient is taking an anticoagulant
Side effects
6%
CostNot available in Canada
RoutineOne pill once a day
Note: Finerenone has only been studied in patients with eGFR <60ml/min/1.73m2 or urine ACR >30mg/mmol - patient does not meet these criteria

Risk of heart attack/stroke in the next 10 years

Risk of heart failure in the next 10 years

Risk of kidney failure in the next 10 years

Risk of severe vision loss in the next 10 years

Risk of pressure sensation loss in the next 10 years

Risk of death in the next 10 years

With current treatment

Adding selected medication(s)

4.9%
4.9%
No Event Event

Risk of all outcomes in the next 10 years

Cumulative relative risk reduction:
0%
Step 4

Summary of Today's Discussion

Based on a discussion of benefits and harms of available options, informed by your own preferences, we have decided to:

Options selected in Step 3 will appear here

"Flozin" (SGLT2 inhibitor)
Monitor for: genital yeast infection, ketoacidosis
GLP-1 receptor agonist
Monitor for: vomiting and/or diarrhea
Metformin
Monitor for: nausea, vomiting, flatulence, and/or diarrhea
DPP-4 inhibitor
Monitor for: heart failure hospitalization (Saxagliptin only), "Gallbladder attack" (cholecystitis)
Statin
Monitor for: muscle pain, elevated liver enzymes, severe muscle damage (called rhabdomyolysis)
Statin
Ezetimibe
Monitor for: none
ACE inhibitor or ARB
Monitor for: cough (ACEI only), hyperkalemia, dizziness, severe swelling of the throat or face (called angioedema; ACEI only)
ACEI inhibitor or ARB
Acetylsalicylic acid (ASA)
Monitor for: major bleeding
Finerenone
Monitor for: hyperkalemia
Target lower blood pressure
Target: 120mmHg systolic
Monitor for: varies based on which medications are used
Insulin
Monitor for: symptomatic low blood sugar, severe low blood sugar
Sulfonylurea
Monitor for: severe low blood sugar

Based on the RECODe clinical prediction model, we estimated the following changes in your risk over the next 10 years with these selected therapies:

Death: 4.9% (from 4.9%)

Heart attack/stroke: 10.3% (from 10.3%)

Heart failure: 2.2% (from 2.2%)

Kidney failure: 6% (from 6%)

Severe vision loss: 6.2% (from 6.2%)


Pressure sensation loss: 6.4% (from 6.4%)



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