When it comes to cancer, probably everyone is scared of it. But many people don’t know that diabetes kills about the same number of people as cancer every year, but not many people worry about high blood sugar, and many people don’t even think of diabetes as a disease. The most classic and apt metaphor for the impact of diabetes on health is “boiling a frog in warm water”. It is also the leading cause of death. The incidence of stroke is two to four times higher in diabetic patients than in non-diabetic patients. The main manifestations of complications of cardiovascular disease include chest tightness, chest pain, crushing heaviness, and in severe cases, myocardial infarction and heart failure; the main manifestations of complications of cerebrovascular disease include dizziness, limb numbness, and in severe cases, cerebrovascular blockage and rupture causing paralysis or even death. Diabetic nephropathy: Diabetic nephropathy is a common microvascular complication, with a prevalence of 20% to 40% in the diabetic population in China, and is one of the most common causes of renal failure. With the prolongation of the disease, about half or more of the glucose patients develop different degrees of proteinuria. Early damage to the kidneys will result in microproteinuria, and aggravated kidney damage will result in massive proteinuria and eventually renal failure. Diabetic retinopathy Diabetic retinopathy is one of the most common and major microvascular complications of diabetes and is the leading cause of blindness in adults. In adults with type 2 diabetes, 20% to 40% develop retinopathy and 8% lose their vision. The main symptoms of the disease are blurred vision and reduced visual acuity; dark shadows in front of the eyes, damage to the macula in the fundus and reduced visual field in both eyes, which can lead to blindness in severe cases. Diabetic neuropathy The occurrence of diabetic neuropathy is related to the course of diabetes and poor glycemic control, including central neuropathy and peripheral neuropathy, of which peripheral neuropathy is common. Among the peripheral neuropathies, distal symmetric polyneuropathy and autonomic neuropathy are the most common. Distal symmetric polyneuropathy is characterized by pain, numbness, and abnormal sensation in both hands or feet; autonomic neuropathy is characterized by nausea, vomiting, difficulty urinating, constipation or diarrhea, upright hypotension, palpitations or bradycardia, and abnormal sweating. Diabetic foot: Diabetic foot is one of the most serious and costly chronic complications of diabetes mellitus, with patients suffering from minor foot ulcers, foot gangrene, or serious amputation. The mechanism of diabetic foot is related to five pathologies, namely neuropathy, vasculopathy, biomechanical abnormalities, lower extremity ulcer formation and infection. Surgical treatment of diabetes: Every diabetic patient, from the day of diagnosis, is told that “diabetes is a long-term chronic disease and must be medicated for life to avoid serious complications.” This statement once became the golden rule in the field of diabetes treatment. However, the emergence of new techniques for the surgical treatment of diabetes has challenged this view, namely the ability of metabolic surgery to achieve prolonged medication withdrawal and long-term blood glucose stabilization in some patients with obese type 2 diabetes. The story begins in the 1980s. At that time, bariatric surgery was already widely used in the treatment of severe obesity. Pories, an American doctor, was one of many surgeons who performed this type of surgery. He was following up on a patient after surgery when he unexpectedly noticed a strange phenomenon: an obese patient with combined type 2 diabetes had a significant drop in blood sugar levels after weight loss surgery until he stopped taking all his glucose-lowering medications. At first, Pories did not care about this, and even doubted the authenticity of the blood glucose test results and the patient’s description, until several patients in succession had similar cases, which caused him to pay attention and think: “Could the surgery used for weight loss, improve, or even cure diabetes?” Over the next decade or so, Pories studied this question in depth, finally publishing his study in 1995: 146 obese patients with combined type 2 diabetes underwent gastric bypass surgery, and after 14 years of follow-up, 121 of them were “cured” of diabetes, i.e., they stopped taking After 14 years of follow-up, 121 of these patients were “cured” of diabetes, i.e., they stopped taking all glucose-lowering drugs and their blood glucose remained normal. More and more clinical studies have confirmed that gastric bypass surgery can significantly reduce blood glucose in diabetic patients, and that surgical treatment is significantly better than traditional drug therapy and can significantly reduce the occurrence of macrovascular and microvascular complications in diabetes; today, the mechanism of surgical treatment of diabetes has become a hot topic of research in gastrointestinal surgery. The American Diabetes Association announced in 2009 that bariatric surgery was officially included as one of the treatment modalities for diabetes, and the Chinese Physicians Association issued the first edition of the ? Chinese Guidelines for the Surgical Treatment of Obesity and Type 2 Diabetes? The surgical approach was formally incorporated into the diabetes treatment protocol and has been widely implemented around the world. Surgery is not suitable for everyone: for the majority of diabetic patients, this is undoubtedly a major benefit. However, it is important to recognize that not all diabetes can be relieved by surgery. For example, type 1 diabetes, basic loss of pancreatic islet function, BMI less than 25, being too old, and being unable to tolerate surgery and anesthesia are all contraindications to surgery. Moreover, the surgery is not the end of the story; patients need post-operative dietary guidance from a health manager and additional vitamin and micronutrient supplementation from a nutritionist as appropriate. It has been proven that the “three-teacher” co-management model, in which the physician, health manager and dietitian work together after surgery, is an important step in maintaining stable blood sugar in diabetic patients in the long term. Overall, surgery has become an important part of the treatment of diabetes. Surgery may be considered for patients with obese type 2 diabetes who meet the indications, especially if medication has not been effective. One more option, or benefit for life.