During the last 10 years, laparoscopic sleeve gastrectomy (LSG) has progressively increased in popularity as a primary procedure because of its simplicity, safety, and effectiveness to achieve sustained weight loss over time. The efficacy of LSG in the metabolic control of type 2 diabetes (T2D) is the result of various mechanisms not thoroughly elucidated. Thus, excellent short-term outcomes have been published in glycemic control after SG at comparable rates to Roux-en-Y gastric bypass (RYGB). Unfortunately, head-to-head comparative studies between SG and RYGB are limited and long-term follow-up data is not abundant. The aim of this manuscript is to describe current evidence on the clinical impact of SG on T2D as well as to provide a critical appraisal of the available published data.