The traditional treatment of diabetes is mainly based on medical therapy, but the surgical method of improving and treating diabetes originated from the accidental discovery of Dr. Pories WJ in the United States thirty years ago – when he performed gastric bypass surgery to treat severe obesity, he found that patients with combined type 2 diabetes lost weight significantly after surgery and their blood sugar also returned to normal rapidly. In 1995, Dr. Pories WJ summarized the results of his more than 600 surgical patients over the past ten years and proposed the concept of “surgical treatment of diabetes”, which caused a great sensation in the medical community, and research in this area continued to emerge, allowing this treatment method to be continuously explored and improved. This has caused a great stir in the medical community, and research on this area has been mushrooming, allowing this treatment to be explored and improved. Many large general hospitals in Shanghai and Beijing have successfully performed this surgery and have accumulated rich clinical experience. Recently, the International Diabetes Federation (IDF) officially defined it as “metabolic surgery”, which clearly defines its status in the treatment of type 2 diabetes. The main procedures of metabolic surgery include gastrointestinal Roux-en-Y bypass (RYGB), biliopancreatic bypass (BPD), and vertical gastric banding (LAGB). RYGB has been found to be the most effective in comparison. However, as the mystery of the concept of “entero-insulin” was unveiled, medical doctors gradually realized that it is actually due to the change of the anatomical sequence of the gastrointestinal tract that causes the change of the secretion pattern of entero-insulin and thus plays a great role in adjusting the metabolism. This is the key to weight loss, glucose reduction and metabolic improvement after surgery! In terms of the applicable population for surgery, currently it is mainly for obese type 2 diabetic patients, for example: for type 2 diabetic patients with body mass index (BMI) ≥ 30 kg/m2, metabolic surgery should be actively considered regardless of the presence of complications; for patients with BMI 28.0 to 29.9 kg/m2, metabolic syndrome should also be actively considered if combined; and for patients with BMI 25.0 to For patients with a BMI of 25.0 to 27.9 kg/m2, they should be fully assisted in weighing the pros and cons, and surgery is not recommended if they have good glycemic control through medical treatment. Patients with type 1 diabetes mellitus, type 2 diabetes mellitus with long duration of disease and patients over 60 years of age or in poor physical condition with poor surgical tolerance are not suitable for surgery. Recent postoperative complications and long-term complications are important issues in metabolic surgery. Recent complications include intestinal obstruction, anastomotic leak, pulmonary embolism and deep vein thrombosis, etc. Their incidence gradually decreases with the improvement of surgical approach and clinical experience, while long-term complications mainly include dyspepsia, dumping syndrome, calcium and vitamin deficiency, etc. These can be maximized by reshaping dietary habits and nutritional guidance to These can be improved and avoided to the greatest extent by reshaping dietary habits and nutritional guidance. Postoperative follow-up is an important part of metabolic surgery management and requires lifelong follow-up of patients by a team of surgeons, endocrinologists and dietitians. Dietary guidance is an important measure to ensure surgical outcomes and reduce complications, with the goal of maintaining improved glucose metabolism while supplementing essential nutrients and avoiding patient discomfort. The effectiveness of metabolic surgery is undeniable, but we still need to treat it with rigor and caution, and not to carry out this work in a “follow the trend” or “campaign” manner, because its long-term effects need to be verified and answered by large-scale, long-term clinical observations and studies. The long-term effects need to be verified and answered by large-scale, long-term clinical observations and studies. Internal medicine remains the foundation of diabetes treatment and is used throughout the entire course of diabetes treatment. On this basis, physicians and surgeons need to work closely and collaborate to form this new interdisciplinary approach for the benefit of diabetic patients!