Quality statement 4: Referring adults with type 2 diabetes for bariatric surgery assessment

Quality statement

Adults with a BMI of 35 or more who have been diagnosed with type 2 diabetes within the past 10 years are offered an expedited referral for bariatric surgery assessment.

Rationale

Bariatric surgery can improve quality of life and reduce the risk of premature mortality for people with obesity and type 2 diabetes of less than 10 years' duration by improving glycaemic control and reducing or delaying the need for medication to control diabetes. An expedited referral means that people do not need to have tried non-surgical measures before they are referred for bariatric surgery assessment. Expedited referrals can be made by tier 3 services or equivalent if tier 3 services are not available locally.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that adults with a BMI of 35 or more who have been diagnosed with type 2 diabetes within the past 10 years are offered an expedited referral for bariatric surgery assessment.

Data source: Local data collection.

Process

Proportion of adults with a BMI of 35 or more who have been diagnosed with type 2 diabetes within the past 10 years who have an expedited referral for bariatric surgery assessment.

Numerator – the number in the denominator who have an expedited referral for bariatric surgery assessment.

Denominator – the number of adults with a BMI of 35 or more who have been diagnosed with type 2 diabetes within the past 10 years.

Data source: Local data collection.

Outcome

Bariatric surgery assessments for adults with a BMI of 35 or more diagnosed with type 2 diabetes within the past 10 years.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (primary and secondary care providers) ensure that adults with a BMI of 35 or more who have been diagnosed with type 2 diabetes in the past 10 years are offered an expedited referral for bariatric surgery assessment.

Healthcare professionals (such as GPs, diabetologists and endocrinologists) ensure that they offer adults with a BMI of 35 or more who have been diagnosed with type 2 diabetes in the past 10 years an expedited referral for bariatric surgery assessment. Healthcare professionals should discuss the benefits and risks of both bariatric surgery and non-surgical treatment when offering referral for assessment.

Commissioners (clinical commissioning groups) ensure that they commission services that can provide an expedited referral for bariatric surgery assessment and that pathways are in place locally to ensure that adults with a BMI of 35 or more who have been diagnosed with type 2 diabetes in the past 10 years are referred to these services. If tier 3 services are not currently commissioned or available, commissioners should ensure that people can be supported and referred by equivalent services until tier 3 services are available.

What the quality statement means for patients and carers

Adults who were diagnosed with type 2 diabetes within the past 10 years and whose body mass index (a measure of height and weight, often shortened to BMI) is 35 or more are offered a referral to find out if they could benefit from an operation to help them lose weight (called bariatric surgery).

Source guidance

Definitions of terms used in this quality statement

BMI

BMI is calculated by dividing weight (in kilograms) by the square of height (in metres).

[Adapted from Obesity: identification, assessment and management (NICE guideline CG189), recommendation 1.2.12]

Expedited referral

The criterion that all appropriate non-surgical measures must have been tried before referral for bariatric surgery can be considered as a treatment option does not apply.

[Adapted from Obesity: identification, assessment and management (NICE guideline CG189)]

Equality and diversity considerations

People of Asian family origin have comorbidity risk factors that are of concern at BMIs different from those of the general population. Clinical judgement is needed when considering risk factors in these groups. Assessment for bariatric surgery for people of Asian family origin diagnosed with type 2 diabetes within the past 10 years should be considered at a lower BMI than other populations.

[Obesity: identification, assessment and management (NICE guideline CG189), recommendation 1.11.3]

Surgical intervention is not generally recommended for children and young people. Bariatric surgery may be considered for young people only in exceptional circumstances and if they have reached or nearly reached physiological maturity.

[Obesity: identification, assessment and management (NICE guideline CG189), recommendations 1.10.12 and 1.10.13]