Introduction：Metabolic and bariatric surgery (MBS) has been an established treatment option for patients with Type 2 diabetes mellitus (T2DM), but there is a relative paucity of evidence-based guidelines on preoperative, operative, and postoperative considerations concerning metabolic surgery for T2DM patients. To address this gap, we initiated a Delphi consensus process with a diverse group of international multidisciplinary experts. 

Method：We embarked on a Delphi consensus-building exercise to propose an evidence-based expert consensus covering various aspects of MBS in patients with T2DM. We defned the scope of the exercise and proposed statements and surveyed the literature through electronic databases. The literature summary and voting process were conducted by 52 experts, who evaluated 44 statements. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.

Results：Consensus, defned as > 80% agreement, was reached for 43 out of 44 statements. The experts reached an agreement on the nature, terminology, and mechanisms of action of MBS. The currently available scores for predicting remission of T2DM after surgery are not robust enough for routine clinical use, and there is a need for further research to enable more personalized treatment. Additionally, they agreed that metabolic surgery for T2DM is costefective, and MBS procedures for treating T2DM vary in their safety and efcacy. 

Conclusion：This Delphi expert consensus statement guides clinicians on various aspects of metabolic surgery for T2DM and also grades the quality of the available evidence for each of the proposed statements.

引言：代谢减重手术（MBS）已成为2型糖尿病（T2DM）患者的成熟治疗选择，但目前缺乏针对T2DM患者代谢手术围术期管理的循证指南。为填补这一空白，我们启动了由多国多学科专家参与的德尔菲共识制定项目。

方法：通过德尔菲共识法构建循证专家共识，覆盖T2DM患者MBS的各个层面。我们界定了研究范围并提出声明条目，通过电子数据库检索文献。由52名专家对44项声明进行文献总结与投票，证据质量采用GRADE（推荐分级的评估、制定与评价）标准评估。

结果：44项声明中43项达成共识（共识定义为>80%赞同率）。专家一致确认：

1.手术本质与机制：明确了MBS的作用机制及术语规范

2.预测工具局限性：现有术后糖尿病缓解预测模型尚不完善，需进一步研究以实现个体化治疗

3.成本效益：代谢手术治疗T2DM具有成本效益优势

4.术式差异：不同MBS术式在安全性和有效性上存在差异

结论：本德尔菲专家共识为临床医生提供了T2DM代谢手术的全面指导，并对每项声明的证据质量进行分级评估。