It is an interesting study because of the large sample size, the length of follow-up and the relatively recent data. 

It is also important because achieving remission of type 2 diabetes mellitus is a critical goal after the emergence of treatments that have demonstrated their feasibility (bariatric surgery and GLP1 and similar therapies). 

It is probably a further confirmation that non-pharmacological or non-surgical treatment, i.e. lifestyle measures, at least conventional ones, are minimally effective under real-life conditions. It is therefore a further call to administrations and health systems to include the new drugs (in addition to or instead of bariatric surgery) in early stages of type 2 diabetes mellitus or even in what we currently call pre-diabetes.  

The fundamental questions to be answered in the latter respect would be:  

1. In which groups these interventions would be really cost-effective (the population with pre-diabetes in developed countries is huge, possibly similar to the prevalence of type 2 diabetes mellitus). 
2. In which cases would bariatric surgery remain the first option. 

The main limitations of the study are that it was conducted in a Hong Kong population, so we do not know to what extent these data can be extended to other populations or ethnicities; and the lack of data to explain weight loss and the methods used (including surgery).