title: Development of type 2 diabetes mellitus thirty-one years after Billroth II in a patient asking for diabetes surgery.
abstract: BACKGROUND
  Diabetes surgery in obese and slim patients seems to be a superior alternative to the current medical treatment. Gastric bypass is an alternative treatment for diabetes. Nevertheless, there are still doubts whether diabetes can recur if you gain weight or if the effects are maintained over time. Other questions refer to the type of surgery to make the bypass limb length or reservoir size for the resolution of the Diabetes Mellitus.
  
  
  METHODS
  Male patient 69-year-old came to us in order to perform tailored One Anastomosis Gastric Bypass (BAGUA) to treat his type 2 diabetes mellitus and metabolic syndrome. He has a history of peptic ulcer treated with subtotal gastrectomy and Billroth II reconstruction 49 years ago. He currently is not obese and developed diabetes 31 years after surgery.
  
  
  CONCLUSIONS
  Globally there are no reports of patients with normal BMI that after performing gastric bypass developed diabetes mellitus. There are cases where obese diabetic patients after gastric bypass improve or remits the T2DM, but it relapses due to insufficient weight loss or gain it. The patient with gastric bypass Billroth II type, should not developed diabetes. He is normal weight and not had weight gain that could be linked to the development of diabetes.
  
  
  CONCLUSIONS
  The results generated by bariatric surgery are encouraging, but still do not clarify the precise way how surgery produces rapid improvement of systemic metabolism as in diabetes, but in our patient, the effect was quite different because the gastric bypass had no protective effect against diabetes.
authors.affiliation: Dept. of Surgery, Medical Faculty. Málaga. Spain.. gcaballe@uma.es.
authors.forename: M
authors.initials: M
authors.lastname: Garciacaballero
authors.affiliation: Dept. of Surgery, Medical Faculty. Málaga. Spain.. alexxanderhola@yahoo.com.mx.
authors.forename: A
authors.initials: A
authors.lastname: Reyes-Ortiz
authors.affiliation: Dept. of Surgery, Medical Faculty. Málaga. Spain. Autonomous University of the State of México. México. U.M.F. 229, Del. 16. Mexican Social Security Institute. México.. josetoval@telefonica.net.
authors.forename: J A
authors.initials: JA
authors.lastname: Toval
authors.affiliation: Dept. of Surgery, Medical Faculty. Málaga. Spain.. jmmartinezm@uma.es.
authors.forename: J M
authors.initials: JM
authors.lastname: Martínez-Moreno
authors.affiliation: Internal Medicine Dept. Associate University Hospital Parque San Antonio. Málaga. Spain.. pacomiralles@yahoo.com.
authors.forename: F
authors.initials: F
authors.lastname: Miralles
mesh_terms: D000368:Aged; D050110:Bariatric Surgery; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery; D005763:Gastroenterostomy; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000601:surgery; D013997:Time Factors