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Diabetes aktuell 2014; 12(2): 80-88
DOI: 10.1055/s-0034-1378124
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© Georg Thieme Verlag Stuttgart · New York

Diabetes und Depressionen – Eine fatale Kombination

Diabetes and depression – a fatal combination
Norbert Hermanns
1   Forschungsinstitut Diabetes, Diabetes Zentrum Mergentheim, Bad Mergentheim
,
Bernhard Kulzer
1   Forschungsinstitut Diabetes, Diabetes Zentrum Mergentheim, Bad Mergentheim
,
Michael Krichbaum
1   Forschungsinstitut Diabetes, Diabetes Zentrum Mergentheim, Bad Mergentheim
› Author Affiliations
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Publication History

Publication Date:
09 May 2014 (online)

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Die Komorbidität von Diabetes und Depressionen stellt eine problematische Konstellation dar, da Depressionen bei Diabetespatienten ein wesentlicher Risikofaktor für einen negativen Verlauf der Erkrankung sind. Dies gilt gleichermaßen für Menschen mit einer subklinisch depressiven Stimmungslage wie auch für Patienten mit einer klinisch manifesten Depression. Depressive Diabetiker weisen bezüglich Morbidität und Mortalität eine deutlich schlechtere Prognose auf als nichtdepressive Diabetiker. Obwohl es effektive Behandlungsmöglichkeiten gibt, werden viele depressive Diabetiker in der klinischen Routine nicht erkannt. Ein regelmäßiges Monitoren des Wohlbefindens und Ansprechen von emotionalen Problemen und diabetesspezifischen Belastungen ist wesentlich, um eine Diagnose und die richtige Behandlung für Depressionen bei Diabetes zu identifizieren. Je nach Schwere der Depressivität und entsprechend der Zusammenhänge mit diabetesspezifischen Problemen lassen sich unterschiedliche Therapiestrategien identifizieren. Bei subklinischen oder leichten klinischen Depressionen, bei denen ein relevanter Zusammenhang zu diabetesspezifischen Problemen besteht, scheint eine Fokussierung der diabetesspezifischen Belastungen durch Schulung, Beratung oder Therapieumstellung sinnvoll. Bei diabetesunspezifischen Auslösern einer depressiven Erkrankung können bei leichteren Formen psychotherapeutische Interventionen oder Beratungen, in schweren Fällen in Kombination mit einer pharmakologischen Therapie Abhilfe schaffen. „Collaborative Care“-Ansätze, in denen eine antidepressive Therapie mit diabetesspezifischen Elementen kombiniert und im Rahmen eines „Stepped Care“-Ansatzes eskaliert werden kann, erscheint nach dem jetzigen Stand der Forschung die Therapie der Wahl bei der Komorbidität von Diabetes und Depression.

Patients with diabetes and depression represent a major challenge for general practitioners, who are responsible for diagnosing and treating the majority of people with type 2 diabetes mellitus and comorbid depression. Diabetic patients with comorbid depression have a markedly poorer prognosis with regard to mortality and morbidity than those without depression. Also, there is a major impact of comorbid depression on patient self-care and treatment outcomes. Therefore, screening for depression in the context of a structured approach to case management and patient follow up is recommended in people with diabetes. Although effective treatment options are available, many diabetic patients with depression are not recognized in the clinical routine. Discussions of the problem and attendance at special diabetic training courses could represent a first step in the treatment of such depressions. When a drug therapy for depression is initiated, attention must be given to possible side effects and/or interactions with diabetes therapy.

Key words

diabetic patients - comorbid depression - self-care - treatment
 

  • Literatur

  • 1 Hauner H. Diabetesepidemie und Dunkelziffer. In: diabetesDE Hrsg. Deutscher Gesundheitsbericht Diabetes 2013. Mainz: Kirchheim-Verlag; 2013: 8-13
    Google Scholar
  • 2 Kulzer B. Verhaltensmedizinische Aspekte der Therapie des Typ-II-Diabetes. Verhaltensmodifikation und Verhaltensmedizin 1990; 3: 317-339
    Google Scholar
  • 3 Fisher L, Skaff MM, Mullan JT et al. A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetes. Diabet Med 2008; 25: 1096-1101
    CrossrefGoogle Scholar
  • 4 Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001; 24: 1069-1078
    CrossrefPubMedGoogle Scholar
  • 5 Ali S, Stone MA, Peters JL, Davies MJ, Khunti K. The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med 2006; 23: 1165-1173
    CrossrefGoogle Scholar
  • 6 IDF Clinical Guidelines Task Force. Global Guideline for Type 2 Diabetes. 2012 December 6 [cited 2012 Dec 6] Available from: URL: http://www.idf.org/sites/default/files/IDF-Guideline-for-Type-2-Diabetes.pdf
    Google Scholar
  • 7 Kulzer B, Albus C, Herpertz S et al. Psychosoziales und Diabetes (Teil 1). S2-Leitlinie Psychosoziales und Diabetes – Langfassung. Diabetologie und Stoffwechsel 2013; 8: 198-242
    Article in Thieme ConnectGoogle Scholar
  • 8 Kulzer B, Albus C, Herpertz S et al. Psychosoziales und Diabetes (Teil 2). S2-Leitlinie Psychosoziales und Diabetes – Langfassung. Diabetologie und Stoffwechsel. In press 2013;
    Google Scholar
  • 9 Moussavi S, Chatterji S, Verdes E et al. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007; 370: 851-858
    CrossrefGoogle Scholar
  • 10 Black SA, Markides KS, Ray LA. Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care 2003; 26: 2822-2828
    CrossrefPubMedGoogle Scholar
  • 11 Sullivan MD, O'Connor P, Feeney P et al. Depression predicts all-cause mortality: epidemiological evaluation from the ACCORD HRQL substudy. Diabetes Care 2012; 35: 1708-1715
    CrossrefGoogle Scholar
  • 12 van Dooren FE, Nefs G, Schram MT et al. Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis. PLoS One 2013; 8
    Google Scholar
  • 13 Bosmans JE, Adriaanse MC. Outpatient costs in pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting. BMC Health Serv Res 2012; 12: 46-46
    CrossrefGoogle Scholar
  • 14 Gonzalez JS, Peyrot M, McCarl LA et al. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care 2008; 31: 2398-2403
    CrossrefPubMedGoogle Scholar
  • 15 Beverly EA, Ganda OP, Ritholz MD et al. Look who's (not) talking: diabetic patients' willingness to discuss self-care with physicians. Diabetes Care 2012; 35: 1466-1472
    CrossrefGoogle Scholar
  • 16 Schunk M, Reitmeir P, Schipf S et al. Health-related quality of life in subjects with and without Type 2 diabetes: pooled analysis of five population-based surveys in Germany. Diabet Med 2012; 29: 646-653
    CrossrefGoogle Scholar
  • 17 Goldney RD, Phillips PJ, Fisher LJ, Wilson DH. Diabetes, depression, and quality of life: a population study. Diabetes Care 2004; 27: 1066-1070
    CrossrefGoogle Scholar
  • 18 De Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosom Med 2001; 63: 619-630
    CrossrefGoogle Scholar
  • 19 Hermanns N, Kulzer B, Krichbaum M, Kubiak T, Haak T. Affective and anxiety disorders in a German sample of diabetic patients: prevalence, comorbidity and risk factors. Diabet Med 2005; 22: 293-300
    CrossrefGoogle Scholar
  • 20 Pouwer F, Beekman AT, Nijpels G et al. Rates and risks for co-morbid depression in patients with Type 2 diabetes mellitus: results from a community-based study. Diabetologia 2003; 46: 892-898
    CrossrefGoogle Scholar
  • 21 Zhang X, Norris SL, Gregg EW. Depressive Symptoms and Mortality among Persons with and without Diabetes. Am J Epidemiol 2005; 161: 652-660
    CrossrefGoogle Scholar
  • 22 Katon WJ, Rutter C, Simon G et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care 2005; 28: 2668-2672
    CrossrefGoogle Scholar
  • 23 Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med 2000; 160: 3278-3285
    CrossrefGoogle Scholar
  • 24 Egede LE, Zheng D, Simpson K. Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care 2002; 25: 464-470
    CrossrefPubMedGoogle Scholar
  • 25 Simon GE, Katon WJ, Lin EH et al. Diabetes complications and depression as predictors of health service costs. Gen Hosp Psychiatry 2005; 27: 344-351
    CrossrefGoogle Scholar
  • 26 Rotella F, Mannucci E. Depression as a risk factor for diabetes: a meta-analysis of longitudinal studies. J Clin Psychiatry 2013; 74: 31-37
    CrossrefGoogle Scholar
  • 27 Nouwen A, Winkley K, Twisk J et al. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia 2010; 53: 2480-2486
    CrossrefPubMedGoogle Scholar
  • 28 Mezuk B, Eaton WW, Albrecht S, Golden SH. Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care 2008; 31: 2383-2390
    CrossrefPubMedGoogle Scholar
  • 29 Pan A, Lucas M, Sun Q et al. Bidirectional association between depression and type 2 diabetes mellitus in women. Arch Intern Med 2010; 170: 1884-1891
    CrossrefGoogle Scholar
  • 30 Nouwen A, Nefs G, Caramlau I et al. Prevalence of Depression in Individuals With Impaired Glucose Metabolism or Undiagnosed Diabetes: A systematic review and meta-analysis of the European Depression in Diabetes (EDID) Research Consortium. Diabetes Care 2011; 34: 752-762
    CrossrefGoogle Scholar
  • 31 Fisher L, Skaff MM, Mullan JT et al. Clinical Depression Versus Distress Among Patients With Type 2 Diabetes: Not just a question of semantics. Diabetes Care 2007; 30: 542-548
    CrossrefGoogle Scholar
  • 32 Fisher L, Mullan JT, Arean P et al. Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care 2010; 33: 23-28
    CrossrefGoogle Scholar
  • 33 Gonzalez JS, Fisher L, Polonsky WH. Depression in diabetes: have we been missing something important?. Diabetes Care 2011; 34: 236-239
    CrossrefGoogle Scholar
  • 34 Rubin RR, Ciechanowski P, Egede LE, Lin EH, Lustman PJ. Recognizing and treating depression in patients with diabetes. Curr Diab Rep 2004; 4: 119-125
    CrossrefGoogle Scholar
  • 35 Katon WJ, Lin EHB, Von Korff M et al. Collaborative Care for Patients with Depression and Chronic Illnesses. N Engl J Med 2010; 363: 2611-2620
    CrossrefGoogle Scholar
  • 36 Hermanns N, Kulzer B, Krichbaum M, Kubiak T, Haak T. How to screen for depression and emotional problems in patients with diabetes: comparison of screening characteristics of depression questionnaires, measurement of diabetes-specific emotional problems and standard clinical assessment. Diabetologia 2006; 49: 469-477
    CrossrefGoogle Scholar
  • 37 Cochran J, Conn VS. Meta-analysis of Quality of Life Outcomes Following Diabetes Self-management Training. Diabetes Educ 2008; 34: 815-823
    CrossrefGoogle Scholar
  • 38 Deakin T, McShane CE, Cade JE, Williams RD. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews CD 003417 2005; 2
    Google Scholar
  • 39 Hermanns N, Kulzer B, Maier B, Mahr M, Haak T. The effect of an education programme (MEDIAS 2 ICT) involving intensive insulin treatment for people with type 2 diabetes. Patient Educ Couns 2012; 86: 226-232
    CrossrefPubMedGoogle Scholar
  • 40 Hermanns N, Kulzer B, Ehrmann D, Bergis-Jurgan N, Haak T. The effect of a diabetes education programme (PRIMAS) for people with type 1 diabetes: Results of a randomized trial. Diabetes Res Clin Pract 2013; 102: 149-157
    CrossrefGoogle Scholar
  • 41 Katon WJ, Von KM, Lin EH et al. The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry 2004; 61: 1042-1049
    CrossrefGoogle Scholar
  • 42 Simon GE, Katon WJ, Lin EH et al. Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Arch Gen Psychiatry 2007; 64: 65-72
    CrossrefGoogle Scholar
  • 43 Available from: URL: DGPPN, DGN, DAlzG. Demenzen (S3-Leitlinie). http://www.awmf.org/uploads/tx_szleitlinien/038-013_S3_Demenzen_lang_11-2009_11-2011.pdf 2009
    Google Scholar