With the development of medical technology, the efficacy and safety of bariatric surgery for the treatment of diabetes is gradually being recognized clinically. However, as of 2012, only the American Diabetes Association (ADA) and the International Diabetes Federation (IDF) have included bariatric surgery in their guidelines for the treatment of diabetes, and the majority of internists still have little understanding of surgical treatment. benefits, and called for the formal inclusion of bariatric surgery in diabetes guidelines. Current Status of Diabetes Control and Bariatric Surgery A study published in 2013 analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 1998 to 2010 and found that between 2007 and 2010, patients with diabetes had higher attainment rates for blood glucose (HbA1c < 7%), blood pressure (BP < 130/80 mmHg), and lipids (LDL-c < 100 mg /dL) were not high, 52.5%, 51.1% and 56.2%, respectively, with only 18.8% of all three. As of 2015, 48% of patients treated with bariatric/metabolic surgery worldwide underwent laparoscopic sleeve gastrectomy (LSG), 42% underwent gastric bypass (GB), 8% underwent laparoscopic adjustable gastric banding (LAGB), and 2% underwent biliopancreatic bypass (BPD). In-hospital mortality rates for bariatric surgery treatment have continued to decline in recent years A survey of in-hospital mortality rates for patients treated with bariatric surgery from 2002 to 2009 showed that with the use of clinical laparoscopic surgical modalities, the American Society for Metabolic and Bariatric Surgery and Surgery (ASMBS) training, and the standardization of bariatric surgery licensure, in-hospital mortality rates for bariatric surgery have continued to decline, from 4.0 per 1000 in 2002 4.0 per 1000 patients in 2002? year to 0.6 per 1000 patient-years in 2009. Postoperative complication rates and mortality rates vary by type of surgery, with the lowest complication rates and lower mortality rates among patients treated with Roux-en-Y gastric bypass (RYGB) Data from a national survey in the United States showed differences in postoperative complication rates and mortality rates among patients with type 2 diabetes treated with eight different types of metabolic or diabetic surgery. The postoperative complication rate was lowest for laparoscopic gastric bypass (LRYGB) treatment, at 3.4%, and the mortality rate for patients treated with LRYGB was only 3 per 1000 patients? years. Another study examined common complications of LRYGB, including early complications (<30 days) including anastomotic fistula with peritonitis, abscess, pulmonary embolism, hemorrhage, pulmonary complications, acute distal gastric dilatation, limb disorders, and wound infection; and long-term complications including anastomotic stricture, anastomotic ulcer, dumping syndrome, intestinal obstruction, internal hernia, incisional hernia, cholecystitis, vitamin and mineral deficiency weight regain, and hypoglycemia. Bariatric surgery treatment improves cardiovascular (CV) risk factors A retrospective analysis of 73 studies (including 3 randomized controlled trials) on bariatric surgery and CV outcomes showed that the mean weight loss of patients after bariatric surgery treatment was 54%; the proportion of patients with substantial remission or improvement in CV risk factors, such as hypertension, diabetes, and hyperlipidemia, increased by 18.1%, 49.2%, and 21.6%, respectively . Bariatric surgery significantly reduces BMI and HbA1c levels Some studies have shown that bariatric surgery improves long-term BMI and HbA1c levels in patients, with the most significant decreases in BMI and HbA1c in patients treated with RYGB. Bariatric surgery reduces long-term mortality by 31%-89% in patients treated with bariatric surgery compared to patients treated without surgery. Randomized Controlled Trial: Bariatric Surgery versus Medication Intensive Therapy in Patients with Diabetes A study compared the effects of bariatric surgery (sleeve gastrectomy [SG], GB) versus medication intensive therapy in patients with diabetes. 3-year follow-up showed that patients treated with bariatric surgery had more significant decreases in HbA1c levels, number of glucose-lowering medications, and body mass index (BMI). Grouping patients by BMI <35 kg/m2 versus BMI ≥35 kg/m2, the improvement in HbA1c was similar in patients treated with weight loss in both groups with different BMIs. Patients treated with weight loss surgery had a higher quality of life compared to those treated with pharmacological intensification. The Short Form of Health Status Survey (SF 36) for patients receiving pharmacological intensive therapy showed no improvement in any of the indicators, while the SF 36 for patients undergoing sleeve gastrectomy showed significant improvements in indicators of general health and energy/fatigue, as well as physical function, physical pain, general health, energy/fatigue, and emotional well-being for patients undergoing gastric bypass. During the 3-year study period, no deaths occurred in the surgical group, and four patients underwent reoperation. Regarding gastrointestinal complications (including intestinal obstruction, ulceration, stricture, leakage, abdominal bleeding, dumping syndrome, and gallstones), a total of 2 cases occurred in the drug-intensive treatment group (n=43); in the bariatric surgery treatment group, 13 cases occurred in patients treated with gastric bypass (n=50); and 5 cases occurred in patients treated with sleeve gastrectomy (n=49). A randomized controlled trial published in the Lancet in 2015 compared weight-reduction-metabolic surgery with conventional drug therapy in obese type 2 diabetic patients with a 5-year follow-up. The results showed that patients treated with bariatric surgery (RYGB, BPD) had more significant weight loss, higher rates of diabetes remission, reduced CV risk to half, and fewer patients continuing to take CV medications (lipid-lowering or antihypertensive drugs) than those treated with conventional medications. Eleven randomized controlled trials have been conducted clinically comparing patients with type 2 diabetes treated with surgery versus medication: with the exception of the Ding 2015 study, all studies showed superior efficacy of surgery over medication (p<0.05), including weight loss, improvements in hba1c, triglycerides (tg), high-density lipoprotein cholesterol (hdl), quality of life (qol) The study showed no patients with early (<30 days) CV events or death, and 15%, 8%, and 5% of patients with anemia, secondary surgery, and functional gastrointestinal disease, respectively, regarding postoperative complications. There was no significant difference in the incidence of hypoglycemia between surgery and drug therapy. (<30 days) CV events or death, 15%, 8%, and 5% of patients with anemia, secondary surgery, and functional gastrointestinal disease, respectively. There was no significant difference in the incidence of hypoglycemia between surgery and drug therapy. Bariatric surgery is cost-effective An analysis of NHANES data from 2009-2010 showed that 53% of medical costs for patients with type 2 diabetes were spent on treating diabetic complications, with macrovascular complications accounting for 57% of complication costs. However, another retrospective analysis confirmed that all (>12) studies demonstrated cost-effectiveness of bariatric surgical treatment, with 1/3 of studies showing medical savings from bariatric surgery. In addition, bariatric surgery is appropriate for people with any level of obesity. As of 2008, no global diabetes organization had included bariatric surgery in their guidelines or position statements. 2009, ADA guidelines recommend that adults with BMI ≥35 kg/m2 and type 2 diabetes be considered for bariatric surgery with long-term lifestyle intervention support and medical monitoring after surgery, but whether bariatric surgery is recommended for patients with BMI <35 kg/m2. There is insufficient evidence to recommend bariatric surgery for patients with BMI <35 kg/m2. Subsequently, the 2011 IDF guidelines also suggested that bariatric surgery should be a treatment option for patients with type 2 diabetes with a BMI ≥ 35 kg/m2; however, unlike the ADA guidelines, the IDF guidelines recommend that patients with poor glycemic control despite optimal drug therapy, especially those with other major CV disease risk factors, may be considered for bariatric surgery even if they have a BMI of 30-35 kg/m2 treatment. In addition, the lower BMI limit for patients eligible for bariatric treatment may be lower in Asia and other ethnic groups at increased risk, such as BMI 27.5-32.5 kg/m2. By 2015, guidelines or position statements issued by the ADA, American Association of Clinical Endocrinologists (AACE), Diabetes UK, IDF, and AHA covered content related to surgical treatment, but the American Endocrine Society (TES), European Association for the Study of Diabetes (EASD), Chinese Medical Association Diabetes Society (CDS), and Indian Diabetes Association still have not included surgical treatment in their guidelines or position statements.