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Alkohol- und Tabakmissbrauch bei Diabetes

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Psychodiabetologie

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Zusammenfassung

Der Konsum von Alkohol ist für Menschen mit Diabetes durchaus möglich, wenn eine entsprechende Schulung erfolgt und ein Patient den Effekt von Alkohol auf den Stoffwechsel abschätzen kann. Ein mäßiger, risikoarmer Alkoholgenuss ist mit einer guten Stoffwechseleinstellung gut vereinbar und weist langfristig sogar gesundheitliche Vorteile auf. Allerdings besteht bei Alkoholkonsum ein erhöhtes Risiko für Hypoglykämien. Als Grenzwerte für einen risikoarmen Konsum gelten 12 g Alkohol pro Tag bei Frauen und 24 g Alkohol pro Tag bei Männern. Oberhalb dieser Grenzwerte spricht man von einem schädlichen/riskanten Alkoholkonsum, der in dem ICD‑10 in der Kategorie „F1 Psychische und Verhaltensstörungen durch psychotrope Substanzen“ abgebildet wird. Übermäßiger Alkoholkonsum ist eine Barriere für eine gute Diabetesbehandlung und mit einem erhöhten Risiko für Folge- und Begleiterkrankungen sowie einer erhöhten Mortalität assoziiert. Wegen der gesundheitlichen Gefahren durch die Abhängigkeit und ihrer negativen Auswirkung auf die Diabetesbehandlung hat die Therapie einer Alkoholabhängigkeitserkrankung bei Patienten mit Diabetes eine besondere Wichtigkeit. Für Formen geringen bis mäßigen Alkoholkonsums oder bei gelegentlichem „binge-drinking“ gelten verhaltensmedizinische Kurzzeitinterventionen als angemessen, während für schwerere Formen einer Alkoholabhängigkeit bzw. eines Alkoholmissbrauchs spezielle Suchttherapien notwendig sind.

Rauchen erhöht bei Personen mit einem erhöhten Typ-2-Diabetesrisiko sowohl das Risiko für die Entwicklung einer gestörten Glukosetoleranz, als auch für die Manifestation eines Typ-2-Diabetes. Bei Menschen mit Diabetes ist Rauchen ein bedeutsamer – und potenziell gut vermeidbarer – Risikofaktor für die Entwicklung von Folgekomplikationen des Diabetes. Menschen mit Diabetes sollen daher darüber aufgeklärt werden, dass Rauchen das Risiko kardiovaskulärer Erkrankungen wie Schlaganfall, Herzinfarkt oder koronare Herzkrankheit erhöht, ein Rauchverzicht auf der anderen Seite nachweisbare positive gesundheitliche Auswirkungen hat. Wegen der Bedeutung des Rauchens für die Prognose des Diabetes sollte jeder Mensch mit Diabetes in der klinischen Praxis regelmäßig – mindestens 1x jährlich – nach dem Tabakkonsum befragt werden und eine mögliche Tabakabhängigkeit festgestellt werden. Hierfür stehen für die Praxis entsprechende Screening- und diagnostische Inventare zur Verfügung. Für die Therapie der Tabakabhängigkeit gibt es psychoedukative Verfahren, psychologische/psychotherapeutische Interventionen sowie medikamentöse Verfahren.

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Authors and Affiliations

  1. Diabetes-Zentrum Mergentheim, Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Theodor-Klotzbücher-Straße 12, 97980, Bad Mergentheim, Deutschland

    Bernhard Kulzer PD Dr. Dipl. -Psych.

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  1. Bernhard Kulzer PD Dr. Dipl. -Psych.
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  1. Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum Ruhr-Universität Bochum, Bochum, Germany

    Frank Petrak

  2. Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum Ruhr-Universität Bochum, Bochum, Germany

    Stephan Herpertz

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Kulzer, B. (2013). Alkohol- und Tabakmissbrauch bei Diabetes. In: Petrak, F., Herpertz, S. (eds) Psychodiabetologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-29908-7_17

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  • DOI: https://doi.org/10.1007/978-3-642-29908-7_17

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