Background: There is evidence that bariatric surgery in patients with BMI > 35 kg/m2 and T2DM is effective at achieving weight loss and leading to remission of T2DM.

Aim: To determine the number of patients with T2DM who meet criteria for recommending bariatric surgery and if so, whether bariatric surgery was discussed during the consultation.

Methods: Retrospective chart audit of patients who attended the Diabetes Centre, Prince of Wales Hospital during 2011 and 2012.

Results: 1139 patients with T2DM were seen and 172 (15.1%) had a BMI > 35 kg/m2. Bariatric surgery was discussed with 23/172 (13.4%). One patient had gastric banding and two consulted a Bariatric surgeon. 6/23 (26%) declined due to personal preference, 5/23 (21.7%) declined due to financial barriers and in 12/23 (52.2%) patients no barriers were identified. 8/23 (34.8%) patients had private health insurance. 53/172 (30.8%) patients had a single contraindication to surgery and 9/172 (5.2%) had 2 or more contraindications to surgery. The most common contraindication was an active psychiatric disorder in 27/172 (15.7%) patients.  The most common co-morbid condition known to respond to bariatric surgery was hypertension, present in 124/172 (72.1%). 100/172 (58.1%) patients had one comorbidity and 34/172 (19.8%) had more than one comorbidity. In 28/110 (25.5%) patients there were no contraindications to surgery and they had private health insurance.  21/28 (75%) patients had private health insurance, no contraindications to bariatric surgery and surgery was not discussed.  Other barriers including duration of T2DM, density of diabetic complications and diabetes management were also examined. 

Conclusion: Bariatric surgery was not usually discussed even when no medical contraindication was present.  A barrier to accessing surgery is cost but physician inertia is also a factor that needs further exploration.