title: [Integrative treatment of instable diabetes mellitus: education or psychotherapy?].
abstract: The term "brittle diabetes" describes a subtype of instable type-I diabetes, characterized by high variations of blood sugar without any evident cause and despite careful clinical management. Clear guidelines for a precise definition of the condition are still lacking; this fosters insecurities concerning diagnosis and therapy of the disease. Psychosocial influences, triggering these conditions, were discussed. The patient-doctor-relationship appears to be tensed due to an often missing compliance. Using a paradigmatic case study as background, the specific diagnostic and therapeutic problems in brittle diabetes were presented. Brittle diabetes advocates a close cooperation between internal and psychosomatic medicine units and a combination of patient education and psychotherapy. Seen under a psychosomatic paradigm, brittle diabetes can be detected early and effective treatment may avoid further complications in these young patients.
authors.affiliation: Klinik für Psychosomatik und Psychotherapie der Universität Giessen. frank.leweke@psycho.med.uni-giessen.de
authors.forename: Frank
authors.initials: F
authors.lastname: Leweke
authors.forename: Regina
authors.initials: R
authors.lastname: Kurth
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Milch
authors.forename: Burkhard
authors.initials: B
authors.lastname: Brosig
mesh_terms: D000293:Adolescent; D015190:Blood Glucose Self-Monitoring / Q000523:psychology; D003131:Combined Modality Therapy; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D010348:Patient Care Team; D010353:Patient Education as Topic; D011575:Psychoanalytic Therapy; D011615:Psychotherapy, Group; D012803:Sick Role
chemical_list: D006442:Glycated Hemoglobin