Skip to main content
SpringerLink
Log in

Diabetes und Psyche

Ein Update

Diabetes and the human psyche

An update

  • Leitthema
  • Published:
Die Diabetologie Aims and scope

Zusammenfassung

Sowohl Typ-1- als auch Typ-2-Diabetes sind häufig mit psychischen Störungen assoziiert. Dazu gehören v. a. Essstörungen und Depression. Die psychische Komorbidität erschwert eine optimale Stoffwechseleinstellung und verschlechtert in vielen Fällen den Diabetesverlauf dramatisch bis hin zu einer erhöhten Mortalität. Psychische Probleme können auch die Adhärenz zur Diabetestherapie negativ beeinflussen. Bei deren psychopharmakologischer Behandlung muss auf die Wahl des Medikaments geachtet werden, da einige Psychopharmaka zu einer nicht unerheblichen Gewichtszunahme führen und damit die Stoffwechseleinstellung verschlechtern können. Mit kognitiv verhaltenstherapeutischen Ansätzen kann man die psychische Komorbidität und auch die Stoffwechseleinstellung positiv beeinflussen. Zu bevorzugen – und auch von der amerikanischen Diabetesgesellschaft empfohlen – ist aber die Einbeziehung einer psychosozialen Behandlung als integraler Bestandteil eines multidisziplinären Teams, die allen Patient:innen mit Diabetes angeboten werden soll, mit dem Ziel, das Therapieergebnis und die Lebensqualität zu optimieren.

Abstract

Both type 1 and type 2 diabetes mellitus (DM) are associated with mental disorders, e.g., eating disorders and depression. Comorbid mental disorders are associated with impaired glycemic control, a higher risk of diabetes complications, and even a higher mortality. Mental problems can also negatively influence adherence to the necessary medical regimens. Regarding psychopharmacological treatment, the choice of drug is essential because many antidepressants and antipsychotics can cause substantial weight gain, which exerts a negative influence on glycemic control. Cognitive behavioral approaches have been shown to successfully reduce mental comorbidity and to also positively influence glycemic control. In their 2022 guidelines, the American Diabetes Association thus recommends that psychosocial care should be integrated into a collaborative, patient-centered approach and be provided to all people with DM, with the goal to optimize health outcomes and health-related quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Abbreviations

95 %-KI:

95 %-Konfidenzintervall

ADA:

„American Diabetes Association“

AHR:

Adjustierte „hazard ratio“

AN:

Anorexia nervosa

BES:

Binge-Eating-Störung

BN:

Bulimia nervosa

DM:

Diabetes mellitus

HbA1c :

Glykiertes Hämoglobin

HPA-Achse:

Hypothalamus-Hypophysen-Nebennierenrinden-Achse

HR:

„Hazard ratio“/Verhältnis der Ereignisse bzw. Gefahren

ICD-10:

„International Classification of Diseases“, 10. Version

ICD-11:

„International Classification of Diseases“, 11. Version

KVT:

Kognitive Verhaltenstherapie

NHANES:

„National Health and Nutrition Examination Survey“

OR:

„Odds ratio“

PHQ‑9:

„Patient health questionnaire“, 9 Fragen, Version für Depressivität

Psy-PAD:

Integriertes psychosomatisches Behandlungsprogramm für Menschen mit Diabetes

RR:

Relatives Risiko

T1D:

Typ-1-Diabetes

T2D:

Typ-2-Diabetes

VT:

Verhaltenstherapie

WHO:

„World Health Organization“

Literatur

  1. Keski-Rahkonen A, Silén Y (2019) Incidence and prevalence of eating disorders among children and adolescents. In: Herpertz-Dahlmann B, Hebebrand J (Hrsg) Eating disorders and obesity in children and adolescents. Elsevier, S 53–62

    Chapter  Google Scholar 

  2. Hedman A, Breithaupt L, Hübel C, Thornton LM, Tillander A, Norring C, Birgegård A, Larsson H, Ludvigsson JF, Sävendahl L, Almqvist C, Bulik CM (2019) Bidirectional relationship between eating disorders and autoimmune diseases. J Child Psychol Psychiatry 60(7):803–812. https://doi.org/10.1111/jcpp.12958

    Article  PubMed  Google Scholar 

  3. Gibbings NK, Kurdyak PA, Colton PA, Shah BR (2021) Diabetic ketoacidosis and mortality in people with type 1 diabetes and eating disorders. Diabetes Care 44(8):1783–1787. https://doi.org/10.2337/dc21-0517

    Article  PubMed  Google Scholar 

  4. Zhang Y, Li S, Zou Y, Wu X, Bi Y, Zhang L, Yuan Y, Gong W, Hayter M (2020) Fear of hypoglycemia in patients with type 1 and 2 diabetes: a systematic review. J Clin Nurs. https://doi.org/10.1111/jocn.15538

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hall R, Keeble L, Sünram-Lea SI, To M (2021) A review of risk factors associated with insulin omission for weight loss in type 1 diabetes. Clin Child Psychol Psychiatry 26(3):606–616. https://doi.org/10.1177/13591045211026142

    Article  PubMed  PubMed Central  Google Scholar 

  6. Nieto-Martínez R, González-Rivas JP, Medina-Inojosa JR, Florez H (2017) Are eating disorders risk factors for type 2 diabetes? A systematic review and meta-analysis. Curr Diab Rep 17:138

    Article  Google Scholar 

  7. Raevuori A, Suokas J, Haukka J, Gissler M, Linna M, Grainger M, Suvisaari J (2015) Highly increased risk of type 2 diabetes in patients with binge eating disorder and bulimia nervosa. Int J Eat Disord 48:555–562

    Article  Google Scholar 

  8. Chevinsky JD, Wadden TA, Chao AM (2020) Binge eating disorder in patients with type 2 diabetes: diagnostic and management challenges. Diabetes Metab Syndr Obes 13:1117–1131. https://doi.org/10.2147/DMSO.S213379

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sattar N, Rawshani A, Franzén S, Rawshani A, Svensson AM, Rosengren A, McGuire DK, Eliasson B, Gudbjörnsdottir S (2019) Age at diagnosis of type 2 diabetes mellitus and associations with cardiovascular and mortality risks. Circulation 139(19):2228–2237. https://doi.org/10.1161/CIRCULATIONAHA.118.037885

    Article  PubMed  Google Scholar 

  10. Thom R, Silbersweig DA, Boland RJ (2019) Major depressive disorder in medical illness: a review of assessment, prevalence, and treatment options. Psychosom Med 81(3):246–255. https://doi.org/10.1097/PSY.0000000000000678

    Article  PubMed  Google Scholar 

  11. Farooqi A, Gillies C, Sathanapally H, Abner S, Seidu S, Davies MJ, Polonsky WH, Khunti K (2022) A systematic review and meta-analysis to compare the prevalence of depression between people with and without type 1 and type 2 diabetes. Prim Care Diabetes 16(1):1–10. https://doi.org/10.1016/j.pcd.2021.11.001

    Article  PubMed  Google Scholar 

  12. Akbarizadeh M, Naderi Far M, Ghaljaei F (2022) Prevalence of depression and anxiety among children with type 1 and type 2 diabetes: a systematic review and meta-analysis. World J Pediatr 18(1):16–26. https://doi.org/10.1007/s12519-021-00485-2

    Article  PubMed  Google Scholar 

  13. Lindekilde N, Scheuer SH, Rutters F, Knudsen L, Lasgaard M, Rubin KH, Henriksen JE, Kivimäki M, Andersen GS, Pouwer F (2022) Prevalence of type 2 diabetes in psychiatric disorders: an umbrella review with meta-analysis of 245 observational studies from 32 systematic reviews. Diabetologia 65(3):440–456. https://doi.org/10.1007/s00125-021-05609-x

    Article  PubMed  Google Scholar 

  14. Lindekilde N, Rutters F, Henriksen EJ, Lasgaard M, Schram MT, Rubin KH, Kivimäki M, Nefs G, Pouwer F (2021) Psychiatric disorders as risk factors for type 2 diabetes: an umbrella review of systematic reviews with and without meta-analyses. Diabetes Res Clin Pract 176:108855. https://doi.org/10.1016/j.diabres.2021.108855

    Article  PubMed  Google Scholar 

  15. Egede LE, Nietert PJ, Zheng D (2005) Depression and all-cause and coronary heart disease mortality among adults with and without diabetes. Diabetes Care 28(6):1339–1345. https://doi.org/10.2337/diacare.28.6.1339

    Article  PubMed  Google Scholar 

  16. Huang CJ, Huang YT, Lin PC, Hsieh HM, Yang YH (2022) Mortality and suicide related to major depressive disorder before and after type 2 diabetes mellitus. J Clin Psychiatry 83(1):20m13692. https://doi.org/10.4088/JCP.20m13692

    Article  PubMed  Google Scholar 

  17. Świątoniowska-Lonc N, Tański W, Polański J, Jankowska-Polańska B, Mazur G (2021) Psychosocial determinants of treatment adherence in patients with type 2 diabetes—a review. Diabetes Metab Syndr Obes 14:2701–2715. https://doi.org/10.2147/DMSO.S308322

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sabaté E (2003) Adherence to long term therapies project. Adherence to long-term therapies: evidence for action. World Health Organization, Genova

    Google Scholar 

  19. Abdoli S, Hessler D, Doosti-Irani M, Chang BP, Stuckey H (2021) The value of measuring diabetes burnout. Curr Diab Rep 21(8):25. https://doi.org/10.1007/s11892-021-01392-6

    Article  PubMed  Google Scholar 

  20. Löwe B, Kroenke K, Gräfe K (2005) Detecting and monitoring depression with a 2-item questionnaire (PHQ 2). J Psychosom Res 58:163–171

    Article  Google Scholar 

  21. Löwe B, Kroenke K, Herzog W, Gräfe K (2004) Measuring depression outcome with a brief self-report instrument: sensitivity to change of the patient health questionnaire (PHQ-9). J Affect Disord 81:61–66

    Article  Google Scholar 

  22. Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, Samara M, Barbui C, Engel RR, Geddes JR, Kissling W, Stapf MP, Lässig B, Salanti G, Davis JM (2013) Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet 382(9896):951–962. https://doi.org/10.1016/S0140-6736[13]60733–3

    Article  CAS  Google Scholar 

  23. Salvi V, Mencacci C, Barone-Adesi F (2016) H1-histamine receptor affinity predicts weight gain with antidepressants. Eur Neuropsychopharmacol 26(10):1673–1677. https://doi.org/10.1016/j.euroneuro.2016.08.012

    Article  CAS  PubMed  Google Scholar 

  24. Yang X, Li Z, Sun J (2020) Effects of cognitive behavioral therapy-based intervention on improving glycaemic, psychological, and physiological outcomes in adult patients with diabetes mellitus: a meta-analysis of randomized controlled trials. Front Psychiatry 11:711. https://doi.org/10.3389/fpsyt.2020.00711

    Article  PubMed  PubMed Central  Google Scholar 

  25. Uchendu C, Blake H (2017) Effectiveness of cognitive-behavioural therapy on glycaemic control and psychological outcomes in adults with diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Diabet Med 34(3):328–339. https://doi.org/10.1111/dme.13195

    Article  CAS  PubMed  Google Scholar 

  26. American Diabetes Association (2022) 5. Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes. Diabetes Care 45(1):S60–S82. https://doi.org/10.2337/dc22-S005

    Article  Google Scholar 

  27. MacGregor KL, DeMartini KS, Barry-Menkhaus SA, Derr AG, Thompson MJ (2021) The impact of integrated behavioral healthcare on glycemic control. J Clin Psychol Med Settings. https://doi.org/10.1007/s10880-021-09817-w

    Article  PubMed  Google Scholar 

  28. Kampling H, Köhler B, Germerott I, Haastert B, Icks A, Kulzer B, Nowotny B, Hermanns N, Kruse J (2022) An integrated psychosomatic treatment program for people with diabetes (psy-PAD)—results of a randomized controlled trial. Dtsch Arztebl Int. https://doi.org/10.3238/arztebl.m2022.0094

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    Martina de Zwaan

Authors
  1. Martina de Zwaan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martina de Zwaan.

Ethics declarations

Interessenkonflikt

M. de Zwaan erklärt, dass sie sich bei der Erstellung des Beitrages nicht von wirtschaftlichen Interessen leiten ließ. Sie legt die folgenden potenziellen Interessenkonflikte offen: Honorare für Vorträge zu psychosozialen Aspekten bei Adipositas von Novo Nordisk.

Für diesen Beitrag wurden von der Autorin keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Zwaan, M. Diabetes und Psyche. Diabetologie 18, 568–574 (2022). https://doi.org/10.1007/s11428-022-00923-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11428-022-00923-3

Schlüsselwörter

Keywords

Search

Navigation