Background and Aims
NHMRC recommends considering bariatric surgery for patients with T2DM and BMI≥35kg/m2. However, access to publicly funded bariatric surgery is limited. Our aim was to assess the proportion of patients meeting the NHMRC criteria for surgery, and how many had been offered an obesity service referral.
Methods
Retrospective audit of all patients with T2DM aged ≥18 years, attending a Sydney public teaching hospital diabetes outpatient service over two years between 01/01/2017 and 31/12/2018.
Results
Of 482 patients, 42.3% had BMI≥35kg/m2 and met NHMRC criteria for bariatric surgery, but only 16% were offered referral to an obesity service. The BMI≥35 group was younger (58.2±13.7 vs 62.0±14.3years, p<0.05) (Mean±SD), with similar diabetes duration (11.9±9.2 vs 12.9±9.1years), with non-significantly more females (51.5% vs 43.5%, p=0.08) and higher starting HbA1c (8.9±2.4% vs 8.5±2.2%, p=0.07). Obstructive sleep apnoea was more prevalent in the BMI≥35 group (25.5% vs 6.5%, p<0.001), with no difference in other co-morbidities. Similar numbers used insulin (63.2% vs 58.6%) and oral anti-diabetes agents, with more GLP1 agonist use in the BMI≥35 group (15.2% vs 7.2%, p<0.01). In the BMI≥35 group, HbA1c dropped significantly during the first year of attendance, but not for those who had attended in previous years (-1.9±3 vs -0.3±1.4, p<0.001), with 27.7% and 23.5% meeting the HbA1c<7% target respectively. There was a similar pattern in the BMI<35 group when comparing new and existing patients (-1.75±3 vs -0.3±1.4, p<0.001), with 43.1% and 46.3% achieving HbA1c<7% respectively.
Conclusions
Many patients attended the public T2DM clinic who met the NHMRC criteria for bariatric surgery, but were not offered a referral. Use of weight lowering medications in these patients was limited, with only a quarter of them achieving an HbA1c<7%. These data support the need to consider obesity management earlier in the management of T2DM.