Perianal abscess andanal fistula are different stages of a disease，mostly caused by anal gland infection. Due to the special metabolic mechanism of diabetes，it is easy to suffer from the perianal abscess and anal fistulaand the condition could be serious. Although most studies have confirmed the safety and reliability of surgical treatment，however，the prognoses of different surgical methods are quite different and the special pathology of diabetes also determines the difference between ordinary patients and those with perianal abscess and anal fistula. At present，there is no consensus on blood sugar control and treatment during the whole operation，and difficult complications such as infection，incontinence，and healing difficulties after surgery also need to be solved urgently. Satisfactory curative effects can be achieved by improving the diagnostic level，stabilizing systemic metabolism， selecting the optimal surgical methods，and standardizing postoperative medication to form a comprehensive diagno⁃ sis and treatment process. Combining its pathogenesis，this article comprehensively reviews the latest research and clinical progress in recent years from the perspective of balanced surgery and systemic comprehensive metabolism， so as to provide an optimal systematic diagnosis and treatment plan.