Recent observational studies demonstrate that bariatric surgical procedures reduce the incidence of type 2 diabetes and lead to substantial improvement or “resolution” for many patients with preexisting disease. Type 2 diabetes has “resolved” (defined in the surgical literature as maintenance of normal blood glucose after discontinuation of all diabetes-related medications, in most studies with HbA1c <7%) in ~77% of patients who undergo obesity surgery, and resolved or improved in ~85%, with sustained improvements in multiple metabolic measures, such as fasting plasma glucose and insulin, percent glycosylated hemoglobin, and use of antidiabetic medications.[2,5–9] Patients with shorter duration of disease seem to have more complete or sustained disease resolution. Furthermore, dyslipidemias and hypertension markedly improve or resolve in 70–95% and 87–95% of surgically treated patients, respectively. In one observational study, gastric bypass surgery resulted in a 40% decreased relative risk of death compared with matched control patients, and diabetes-related deaths were reduced by 92%. Health economic evaluations suggest reductions in use of medications and overall health care costs for patients with type 2 diabetes who have undergone bariatric surgery. Although some physicians consider bariatric surgery draconian, these data suggest important health benefits of surgical interventions in patients with type 2 diabetes with BMI >35 kg/m2 and raise the question of whether surgical interventions should be considered earlier in the course of disease or for lesser magnitude of excess weight and specifically for the treatment of diabetes as opposed to treatment of obesity.