Approaches to the management of pathologic reflux range from the use of histamine H2-receptor blockers and prokinetic medications to surgery in severe cases. Diabetic Neuropathy Jesse A. Lipnick, M.D., Gainesville, Florida Thomas H. Lee, M.D., Grant Medical Center, Columbus, Ohio Diabetic neuropathy affects up to 60 percent of the estimated 13 million Americans who have diabetes mellitus. Foot and ankle complications are responsible for more hospital admissions than all other complications of diabetes mellitus combined. Neuropathy is more likely to affect patients who have higher degrees of hyperglycemia and a longer history of diabetes, and those who are older, taller and male. Diabetic neuropathy is usually diagnosed by the loss of ankle reflexes and distal vibratory sensation, but these signs may not always be present.
Electromyography is useful in establishing a diagnosis.
Treatment is directed toward alleviating the symptoms and correcting the underlying pathogenesis. Strict glycemic control is key in the ultimate prevention of diabetic neuropathy. The family physician can play a significant role in preventing this complication by emphasizing the importance of strict glycemic control. Before preventive therapy is initiated, the radiographic abnormalities must be differentiated from those representing active disease. According to recommendations from the American Thoracic Society and the Centers for Disease Control and Prevention, patients with latent tuberculosis who exhibit fibronodular changes or silicosis on chest radiographs should be given either isoniazid alone for one year or the combination of isoniazid and rifampin for four months, preferably with pyrazinamide for the first two months.