Metabolic surgery has a strong evidence base as a treatment for type 2 diabetes. Twelve randomized controlled trials have demonstrated that metabolic surgery is relatively safe and superior to lifestyle intervention and medications for achieving glycemic control in patients with type 2 diabetes and obesity. Long-term remission of type 2 diabetes has been reported to occur in 20-60% of patients after metabolic surgery while it is only observed rarely after medical treatment. Observational studies have shown that metabolic surgery reduces cardiovascular events and mortality by 40%. The American Diabetes Association Standards of Care for Diabetes recommends metabolic surgery for patients with type 2 diabetes and severe obesity. More than 50 diabetes organizations have adopted similar guidelines for metabolic surgery.