In 1982, Professor Pories et al. discovered by chance in the surgical treatment of morbid obesity that patients with combined type 2 diabetes who underwent bariatric surgery lost significant weight and had a rapid return to normal blood glucose, thus opening up a new avenue of treatment for type 2 diabetes – surgery. RCTs have confirmed that surgery for type 2 diabetes shows better results than medication in terms of glycemic control and diabetic complications at short-term follow-up over a 2-year period, but there is a lack of research to determine whether these results change at long-term follow-up. For this reason, Professor Mingrone and his team from Italy conducted a randomized, non-blinded, single-center pilot study, the results of which were recently published in the journal The Lancet. The study enrolled 60 patients with similar underlying conditions of type 2 diabetes (entry criteria: 30-60 years, BMI ≥ 35, HbA1c ≥ 7%, history of diabetes for more than 5 years, no serious complications), divided into 3 groups of 20 patients each, who were treated with medication, Roux-en-Y gastrointestinal bypass and biliopancreatic open heart surgery. Main results: 1. 15 patients in the drug group completed the study after 5 years of follow-up, and 19 patients in both the gastrointestinal bypass and biliopancreatic groups completed the study. 2. In comparison, 7 patients (37%) in the gastrointestinal bypass group and 12 patients (63%) in the biliopancreatic group achieved remission at 5 years (FPG ≤ 5.6-6.9 mmol/L and HbA1c < 6.5% without the aid of other treatments for at least 1 year after surgery), while none of the patients in the pharmacologic group achieved this outcome. There was a significant difference in the effect of comparing surgical and pharmacological treatment. 3. Relaxing the efficacy criteria to HbA1c ≤ 6.5% without or with glucose-lowering drugs, a further comparison showed that 4 (27%) of the drug group met the criteria, while 8 (42%) of the surgical patients in the gastrointestinal bypass group and 13 (68%) in the biliopancreatic group met the criteria, and there was still a significant difference between the drug and surgical outcomes. It is noteworthy that the need for medications to lower glucose after surgery was greatly reduced. 33 patients (87%) did not require medications (but did require diet, etc.) to control hyperglycemia 5 years after surgery. 18 patients who required insulin to lower glucose before surgery did not require insulin to lower glucose 5 years after surgery in 17 patients. In contrast, insulin use in the drug group increased over the course of follow-up. In addition, the surgical patients outperformed the drug group in all aspects of post-treatment weight loss, lipid reduction, reduced risk of cardiovascular events, and reduced diabetic complications. Accordingly, the investigators concluded that bariatric surgery is more effective than drug therapy in treating type 2 diabetes and that half of the patients who underwent surgery achieved long-term remission after surgery. However, the researchers also noted that 15 of the 34 patients (44%) who met the criteria for remission at the second-year follow-up had some rebound in blood glucose at the subsequent follow-up, reminding clinicians of the need to monitor blood glucose over time even after surgery has achieved good results. The specific mechanism of surgical treatment of diabetes is still unclear, and although the patients lost significant weight after surgery, the study showed no significant correlation between the improvement of diabetes and the degree of weight loss, suggesting that researchers could interpret the results in terms of the effect of surgery on hormones and signaling factors in the gastrointestinal tract. It is believed that exploring the mechanism of surgery for diabetes will also become a hot spot for future research. Although gastric bypass surgery is more effective in weight reduction and glucose lowering, than sleeve gastrectomy. However, postoperative complications are indeed more frequent, and we prefer patients to undergo sleeve gastrectomy surgery when both procedures can be performed.