Quality standard
Quality statement 4: Referring adults with type 2 diabetes for bariatric surgery assessment
Quality statement 4: Referring adults with type 2 diabetes for bariatric surgery assessment
Quality statement
Adults with a body mass index (BMI) of 35 kg/m2 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
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements and written clinical protocols to ensure that adults with a BMI of 35 kg/m2 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: Evidence can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service pathways and protocols.
Process
Proportion of adults with a BMI of 35 kg/m2 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 kg/m2 or more who have been diagnosed with type 2 diabetes within the past 10 years.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
What the quality statement means for different audiences
Service providers (primary and secondary care providers) ensure that adults with a BMI of 35 kg/m2 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 kg/m2 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 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 kg/m2 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.
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 kg/m 2 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
Obesity: identification, assessment and management. NICE guideline CG189 (2014, updated 2023), recommendation 1.10.3
Definitions of terms used in this quality statement
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 NICE's guideline on obesity: identification, assessment and management]
Equality and diversity considerations
People of South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family background who are prone to central adiposity 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. Expedited assessment for bariatric surgery for people of these family backgrounds who are prone to central adiposity and who have recent-onset (diagnosed within the past 10 years) type 2 diabetes should be considered at a lower BMI than other populations (reduced by 2.5 kg/m2) as long as they are also receiving, or will receive, assessment in a specialist weight management service. [NICE's guideline on obesity: identification, assessment and management, recommendation 1.10.5]
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. [NICE's guideline on obesity: identification, assessment and management, recommendations 1.10.21 and 1.10.22]