The diagnostic criteria for super obesity with type 2 diabetes mellitus include that body mass index (BMI) is above 50 kg/m², fasting plasma glucose (FPG) is greater than 7.0 mmol/L, and insulin and C-peptide secretion levels at each time point of oral glucose tolerance test (OGTT) are higher than those in fasting state. Metabolic surgery is almost the only effective treatment for patients with super obesity and type 2 diabetes. Therefore, the scientific perioperative management is the key to ensuring the safety of operation and improving the long-term results. Perioperative risks include the risk of the procedure itself, the risk of obesity-related diseases, and the risk of abnormal blood sugar. To reduce the perioperative risks, the following questions are required to be clarified: (1) whether there are effective interventions; (2) how long the intervention will last and what effect it will achieve; (3) whether there is an alternative solution if the expected effect cannot be achieved. Here, the authors put together the perioperative management process for patients with super obesity and type 2 diabetes by reviewing and extracting data from the domestic and foreign literature in recent years, so as to provide a reference for clinical treatment.