Background With the continuous efforts of scholars all over the world, various new drugs have been introduced and the treatment of diabetes is becoming increasingly different by the month. However, no treatment has yet emerged to cure diabetes, and surgeons have found in clinical practice that many obese patients with diabetes themselves have improved or even completely resolved their diabetes after undergoing bariatric surgery. Historically, there have been no studies comparing the efficacy of bariatric surgery with conventional medical therapy. The study conducted by Dr. Dixon et al. entered into a bold design: bariatric surgery was used as the only treatment for some patients with type 2 diabetes, and all medical medications were not applied except for increased exercise and diet control. The study procedure The more common procedures currently performed include gastric ballooning, gastric banding, and gastric bypass. In this study, a gastric banding procedure was used, in which the investigators laparoscopically disposed of a rubber band in the upper part of the stomach near the esophagus, narrowing the stomach into two upper and lower parts, which could be easily adjusted by the surgeon from outside the body. A total of 60 patients who presented to the Monash University Obesity Research Centre in Australia from December 2002 to December 2006, all with obesity (BMI between 30 and 40 kg/m2) and diagnosed T2DM within 2 years, were randomly and equally grouped to receive gastric banding or standard medication (e.g., insulin, metformin, etc.). Patients were considered to be in complete remission of T2DM if fasting glucose was <7.0 mmol/L and HbAlc was <6.2%. The statistical results were analyzed by intention-to-treat analysis. A total of 55 (92%) of the 60 patients completed more than 2 years of follow-up. In the group of patients treated with gastric banding, 22 (73%) had complete remission of T2DM, while only 4 (13%) of the conventional drug treatment group achieved complete remission. The relative risk-remission ratio for the surgical group was 5.5 (95% CI 2.2 to 14.0). Patients in the surgical treatment group lost a mean of 20.7% (SD 8.6%) of their body weight compared to a mean of 1.7% (SD 5.2%) in the drug treatment group. There was a high correlation between T2DM remission rate and weight loss in patients (r2=0.46, P<0.001). No significant side effects were found in either treatment group. The study is a medical sensation. Previous studies have reported that if patients with T2DM can lose 10% of their body weight, they can achieve significant improvement or even complete remission. With no current cure for diabetes, this treatment to reverse the disease is sure to generate a strong academic response. Many medical authorities have commented on this study. 1. The JAMA journal has invited Dr. David E. Cummings, professor of internal medicine in the Division of Metabolism, Endocrinology and Nutrition at the University of Washington, and Dr. David R. Flum, professor of surgery, to comment on this topic. "We traditionally think of diabetes as a chronic, progressive disease," the article reads, "but these bariatric procedures (gastric banding, gastric bypass, etc.) represent a tangible hope for a cure for diabetes." 2, Diabetes experts also cautiously praised the research findings, hoping that the next study will clarify how the risks of surgery compare with the effects of diabetes medication and how effective the long-term follow-up is. "There is growing evidence that weight loss surgery is an effective treatment for diabetes," said Dr. John Buse, chairman of the ADA's Division of Medicine and Science and of the University of North Carolina School of Medicine, "The question is, how effective is it? What is the range of indications? What stage of T2DM is it appropriate for? What is the cost? These questions cannot be answered immediately at this time." 3, Surgical therapists praised the findings. "Few studies can claim to be groundbreaking, and this study is one of them," described Dr. Philip Schauer, director of the Institute for the Treatment of Obesity and Metabolism at Cleveland Hospital, "and it opens up a whole new way of understanding diabetes and its treatment. " Dr. Schauer is also conducting a similar study aimed at comparing the efficacy of different surgical procedures with standard medical treatments. He describes the National Institutes of Health (NIH) rule that weight-loss surgery is indicated for patients with a BMI over 40 kg/m2, and that the surgical criteria can be relaxed to a BMI of 35 kg/m2 or more if there is concomitant T2DM, for which their research center has already referred away three to four patients who should have undergone surgery. "This unreasonable rule should be improved," Dr. Schauer said, "and the BMI threshold should be lowered, at least not to the point where it is now considered that BMI = 34.9 kg/m2 is not an indication for surgery." The chief of metabolic surgery at Presbyterian/Weill Cornell Medical Center in New York also said, "The surgical criteria should be changed so that patients with diabetes can reverse their condition earlier with the help of surgery." He noted that reconstruction of the small intestine (such as gastric bypass) can be very effective quickly, and that gastric banding can also improve gastrointestinal hormones that affect blood sugar, weight and lipid levels. Both bariatric surgery and gastrointestinal hormones are now hot topics of research. 4, Dr. John Dixon, the study's author, said confidently, "Surgery for diabetes will become more popular in the next few years," and other members of the research team were even more excited about the topic: "Surgical treatment of patients with diabetes is the most significant discovery since the invention of insulin. The discovery is the most significant since the invention of insulin. Of course, this small study (60 patients) has some limitations: the patients selected for the study had a BMI between 30 and 40 kg/m2, and the follow-up period was relatively short (only 2 years). This conclusion, however, needs to be evaluated for efficacy in larger populations and in longer-term studies." Outlook Although weight loss surgery has been available for more than three decades, this is the first time it has been used as an important treatment for T2DM. The study will reportedly be presented at the Diabetes Surgery Conference in Rome, where surgical treatment of diabetes will be more widely discussed. If further research can shed more light on the mechanism and feasibility of this treatment method, it will undoubtedly bring benefits to countless T2DM patients around the world.