According to the WHO, the incidence of diabetes in the world is increasing significantly year by year. The current prevalence of diabetes in adults in China is about 9.7%, with a total of about 90 million, of which type 2 diabetes accounts for 90%. Diabetes is an ancient medical disease, and traditional medical treatment is difficult to cure it fundamentally. Moreover, strict dietary control and repeated blood glucose fluctuations cause continuous mental stress to patients, which seriously affects health and quality of life, and cannot avoid complications. Diabetes usually coexists with obesity. In the past 40 years, a large number of studies on bariatric surgery in Europe and the United States have found that the accompanying diabetes was cured along with significant weight loss. Surgical treatment of diabetes has attracted great attention, especially the majority of sugar lovers have high expectations for this new treatment method. The main mechanisms of gastrointestinal surgery for the treatment of diabetes may be: (1) reduction of food intake and absorption, thus reducing energy intake and glucose metabolic load; (2) reduction of the patient’s body weight and reduction of insulin resistance caused by fat accumulation due to simple obesity; (3) alteration of the secretion of the intestine-insulin axis after gastrointestinal tract reconstruction, thus improving glucose metabolism. There are five clinically proven surgical approaches for the treatment of type 2 diabetes, namely gastrointestinal Roux-Y short-circuit, mini-gastrointestinal short-circuit, biliopancreatic open-loop, duodenal transposition, sleeve gastrectomy, and adjustable gastric banding. Different physicians may prefer different surgical approaches for different patients. There is no optimal surgical approach, but gastrointestinal Roux-Y short-circuit surgery is the most popular and respected. The surgery can again be either minimally invasive laparoscopic surgery or conventional open surgery. Minimally invasive laparoscopic surgery is as effective as conventional open surgery, but with less trauma, less bleeding, faster recovery, relatively fewer complications, and cosmetic results, making the advantages more obvious. All type 2 diabetic patients with poor results or intolerance after long-term non-surgical treatment can be considered for gastrointestinal surgery, but the following conditions must be met to achieve good results: (1) age below 65 years; (2) duration of diabetes <15 years; (3) islet function at least 1/2 of the lower limit of normal. According to the guidelines of the Endocrine Surgery Group of the Chinese Medical Association, the operator should be a gastrointestinal surgeon with intermediate title or above practicing in general surgery. The patient must be fully evaluated by a team of related departments such as gastrointestinal surgery, endocrinology, anesthesiology, cardiology, neuropsychiatry, and nutrition before surgery. Any surgery is traumatic and risky to the body, and naturally diabetes surgery is no exception. The main complications include: gastrointestinal anastomotic leak, infection, bleeding, intestinal obstruction, etc. The incidence of these complications is low, however, and is worth it relative to the benefits of surgical treatment of diabetes. In the long run, the surgery may affect the absorption of some micronutrients, which will need to be supplemented accordingly after surgery. Another thing is that surgery can lead to weight loss, especially for diabetes with concomitant obesity. However, the weight loss is not unlimited, and generally the weight loss will be maintained in a relatively stable state when it is close to normal weight. Regular post-operative reviews and lifelong follow-up are necessary to guide patients to proper rehabilitation. Therefore, from the above perspective, as a surgeon, the advice I would like to give to the majority of patients is that surgery for type 2 diabetes is a new and trustworthy method at present, but still needs to be chosen carefully in order to achieve good results and reduce the risks of surgery. It is best to choose a large general hospital with minimally invasive surgical conditions and rich experience in minimally invasive gastrointestinal surgery, capable of multidisciplinary collaboration between medicine and surgery.