Severe obesity in a specialist type 2 diabetes outpatient clinic: an Australian retrospective cohort study

Abstract Background Obesity is a major risk factor for the development of type 2 diabetes (T2DM) and its complications. Significant weight loss has been shown to improve glycaemia in people with T2DM and obesity. National and international guidelines recommend considering bariatric surgery for body...

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Main Authors: Arunav Thakur, Dharmesh Sharma, Bhavya Gupta, Nikitha Kramadhari, Rohit Rajagopal, David Simmons, Milan Kumar Piya
Format: Article
Language:English
Published: BMC 2021-03-01
Series:BMC Endocrine Disorders
Subjects:
Online Access:https://doi.org/10.1186/s12902-021-00722-9
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spelling doaj-ab269234f467452495efb18e145493972021-03-28T11:18:58ZengBMCBMC Endocrine Disorders1472-68232021-03-012111910.1186/s12902-021-00722-9Severe obesity in a specialist type 2 diabetes outpatient clinic: an Australian retrospective cohort studyArunav Thakur0Dharmesh Sharma1Bhavya Gupta2Nikitha Kramadhari3Rohit Rajagopal4David Simmons5Milan Kumar Piya6School of Medicine, Western Sydney UniversitySchool of Medicine, Western Sydney UniversitySchool of Medicine, Western Sydney UniversitySchool of Medicine, Western Sydney UniversityMacarthur Diabetes Service, Camden and Campbelltown HospitalsSchool of Medicine, Western Sydney UniversitySchool of Medicine, Western Sydney UniversityAbstract Background Obesity is a major risk factor for the development of type 2 diabetes (T2DM) and its complications. Significant weight loss has been shown to improve glycaemia in people with T2DM and obesity. National and international guidelines recommend considering bariatric surgery for body mass index (BMI) ≥ 35 kg/m2. We assessed the proportion of people with T2DM meeting criteria for surgery, how many had been offered a bariatric/obesity service referral, and compared the characteristics of people with BMI ≥ 35 kg/m2 and BMI < 35 kg/m2. Methods Retrospective data were collected for all people with T2DM aged ≥18 years, attending a hospital specialist diabetes outpatient service over three calendar years, 2017–2019. Results Of 700 people seen in the service, 291 (42%) had BMI ≥ 35 kg/m2 (the “BMI ≥ 35 group”) and met criteria for bariatric surgery, but only 54 (19%) of them were offered referral to an obesity service. The BMI ≥ 35 group was younger than those with a BMI < 35 kg/m2 (56.1 ± 14.8 vs 61.4 ± 14.6 years, p < 0.001) (mean ± SD), with similar diabetes duration (11.0 ± 9.0 vs 12.3 ± 8.9 years, p = 0.078), and there was no significant difference in initial HbA1c (75 ± 27 vs 72 ± 26 mmol/mol, p = 0.118) (9.0 ± 2.5 vs 8.7 ± 2.4%) or proportion treated with insulin (62% vs 58%). There was more GLP1 agonist use in the BMI ≥ 35 group (13% vs 7%, p = 0.003) but similar rates of SGLT2 inhibitor use (25% vs 21%, p = 0.202). The BMI ≥ 35 group received more new medication and/or dose adjustments (74% vs 66%, p = 0.016). Only 29% in the BMI ≥ 35 kg group achieved HbA1c < 53 mmol/mol (7.0%). Conclusions In spite of frequently meeting the criteria for bariatric surgery and not achieving glycaemic targets, people with T2DM in this specialist clinic received limited medical or surgical management of their obesity. This study suggests opportunities for improvement in care of people with T2DM at several levels including increased referrals from T2DM services to weight management/bariatric services, as well as an increased use of GLP1 agonists and SGLT2 inhibitors where appropriate. Our data support the need to prioritise obesity management in the treatment of type 2 diabetes.https://doi.org/10.1186/s12902-021-00722-9ObesityHealth care deliveryType 2 diabetesBariatric
collection DOAJ
language English
format Article
sources DOAJ
author Arunav Thakur
Dharmesh Sharma
Bhavya Gupta
Nikitha Kramadhari
Rohit Rajagopal
David Simmons
Milan Kumar Piya
spellingShingle Arunav Thakur
Dharmesh Sharma
Bhavya Gupta
Nikitha Kramadhari
Rohit Rajagopal
David Simmons
Milan Kumar Piya
Severe obesity in a specialist type 2 diabetes outpatient clinic: an Australian retrospective cohort study
BMC Endocrine Disorders
Obesity
Health care delivery
Type 2 diabetes
Bariatric
author_facet Arunav Thakur
Dharmesh Sharma
Bhavya Gupta
Nikitha Kramadhari
Rohit Rajagopal
David Simmons
Milan Kumar Piya
author_sort Arunav Thakur
title Severe obesity in a specialist type 2 diabetes outpatient clinic: an Australian retrospective cohort study
title_short Severe obesity in a specialist type 2 diabetes outpatient clinic: an Australian retrospective cohort study
title_full Severe obesity in a specialist type 2 diabetes outpatient clinic: an Australian retrospective cohort study
title_fullStr Severe obesity in a specialist type 2 diabetes outpatient clinic: an Australian retrospective cohort study
title_full_unstemmed Severe obesity in a specialist type 2 diabetes outpatient clinic: an Australian retrospective cohort study
title_sort severe obesity in a specialist type 2 diabetes outpatient clinic: an australian retrospective cohort study
publisher BMC
series BMC Endocrine Disorders
issn 1472-6823
publishDate 2021-03-01
description Abstract Background Obesity is a major risk factor for the development of type 2 diabetes (T2DM) and its complications. Significant weight loss has been shown to improve glycaemia in people with T2DM and obesity. National and international guidelines recommend considering bariatric surgery for body mass index (BMI) ≥ 35 kg/m2. We assessed the proportion of people with T2DM meeting criteria for surgery, how many had been offered a bariatric/obesity service referral, and compared the characteristics of people with BMI ≥ 35 kg/m2 and BMI < 35 kg/m2. Methods Retrospective data were collected for all people with T2DM aged ≥18 years, attending a hospital specialist diabetes outpatient service over three calendar years, 2017–2019. Results Of 700 people seen in the service, 291 (42%) had BMI ≥ 35 kg/m2 (the “BMI ≥ 35 group”) and met criteria for bariatric surgery, but only 54 (19%) of them were offered referral to an obesity service. The BMI ≥ 35 group was younger than those with a BMI < 35 kg/m2 (56.1 ± 14.8 vs 61.4 ± 14.6 years, p < 0.001) (mean ± SD), with similar diabetes duration (11.0 ± 9.0 vs 12.3 ± 8.9 years, p = 0.078), and there was no significant difference in initial HbA1c (75 ± 27 vs 72 ± 26 mmol/mol, p = 0.118) (9.0 ± 2.5 vs 8.7 ± 2.4%) or proportion treated with insulin (62% vs 58%). There was more GLP1 agonist use in the BMI ≥ 35 group (13% vs 7%, p = 0.003) but similar rates of SGLT2 inhibitor use (25% vs 21%, p = 0.202). The BMI ≥ 35 group received more new medication and/or dose adjustments (74% vs 66%, p = 0.016). Only 29% in the BMI ≥ 35 kg group achieved HbA1c < 53 mmol/mol (7.0%). Conclusions In spite of frequently meeting the criteria for bariatric surgery and not achieving glycaemic targets, people with T2DM in this specialist clinic received limited medical or surgical management of their obesity. This study suggests opportunities for improvement in care of people with T2DM at several levels including increased referrals from T2DM services to weight management/bariatric services, as well as an increased use of GLP1 agonists and SGLT2 inhibitors where appropriate. Our data support the need to prioritise obesity management in the treatment of type 2 diabetes.
topic Obesity
Health care delivery
Type 2 diabetes
Bariatric
url https://doi.org/10.1186/s12902-021-00722-9
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