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Severe obesity with type 2 diabetes — SCE Endocrinology MCQ

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ModerateObesity/LipidsSevere obesity with type 2 diabetesSCE Endocrinology

A 35-year-old woman has severe obesity with BMI 44 kg/m² and type 2 diabetes for 4 years. HbA1c is 76 mmol/mol despite metformin, SGLT2 inhibitor and GLP-1 receptor agonist therapy. She has obstructive sleep apnoea and has completed a specialist weight-management programme. What is the most appropriate management?

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Correct answer: B — Refer for bariatric metabolic surgery assessment

Bariatric/metabolic surgery assessment is appropriate in severe obesity with inadequately controlled type 2 diabetes after specialist weight-management intervention. Endocrine treatment alone is not a substitute for obesity service assessment. The pearl is that metabolic surgery is a diabetes treatment in selected patients, not solely weight treatment.

Reference: NICE obesity guideline NG246, NICE NG28