Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia caused by multiple factors and accompanied by abnormal metabolism of sugar, fat and protein due to defective insulin secretion and/or action. Among them, type 2 diabetes accounts for more than 90%. The treatment of diabetes has always been a medical challenge. The inability to completely cure it, the inability to avoid the development of complications and the gradual decline in quality of life are the current status of diabetes treatment. The reason for this is the inability to change the metabolic disorder of the body, which is the fundamental factor leading to the development of diabetes. From the “troika” of diabetes treatment, there are now “six troika” and even “seventh troika”. The treatment effect has not improved much. There are more and more “horses” pulling the “car”, but the “car” is still not pulling well, indicating that the role of these “horses” is still limited. The role of these “horses” is still limited. This has forced us to reconceptualize the disease; to question the original treatment methods; to change our thinking and find new, effective treatments. Bariatric surgery, which began fifty years ago, opened a window that gave us many new insights into diabetes. After thirty years of research, practice and summary, a brand new treatment, surgery, has finally been officially included in the treatment guidelines for diabetes. Through these two years of clinical practice, there is no doubt about its therapeutic efficacy, safety and effectiveness in treating complications. Although the mechanism of treatment is not completely clear, and there are still many ways and means of surgery that should be summarized and improved, the basic principle that the purpose of surgery is to change the metabolic state of the body is consistent with the theoretical basis that the pathophysiological basis of diabetes is metabolic disorders. Many people, including many endocrinologists engaged in the treatment of diabetes, believe that the reduction of food intake caused by surgery is the root cause of the drop in blood glucose, and that in the long run, patients will suffer from malnutrition. This is completely wrong. If this is the case, why rely on surgery to reduce the patient’s food intake when active restriction of food intake would be sufficient? What about the fact that the reduction in the amount of food eaten by the patient after surgery does not cause a hypoglycemic reaction? Is the increase of insulin secretion level and the reduction of insulin resistance in patients not caused by diet control? How can duodenojejunostomy and ileal transposition with complete preservation of the stomach cause the same decrease in the amount of food eaten by the patient after surgery? How can the decrease in appetite of the patient after this procedure be explained by a reduction in gastric volume? In fact, all of this goes back to the question, do people who eat more necessarily get fat and get diabetes? The answer is naturally no. Therefore, this new approach to diabetes treatment has its justifications, but also its imperfections. For example, how to avoid the short-term weakening of gastric power after surgery? Will there be a rebound of blood sugar in the long term? All these need to be further studied and summarized. In addition, the surgical approach also needs to be further improved and standardized. More importantly, more people need to be involved in the pathophysiological study of this new method to clarify its pathophysiological basis as soon as possible. After more than one year of clinical practice and research, as well as observation and evaluation of treatment effects, we have confidence and reason to believe that the “new triad” of diabetes treatment in the future will be: surgery, diet, and exercise.