History and clinical presentation: A 65-year-old man with type 2 diabetes mellitus and unfavorable metabolic values in combination with obesity and arterial hypertension and considerable psychosocial strains presented at a psychosomatic outpatient clinic. During the course of diagnostic sessions a problematic illness behavior as well as a depressive symptomatology that had developed after the death of his wife a few years earlier became apparent. DIAGNOSIS, THERAPY, COURSE: An avoidant illness behavior and a moderate depressive episode were diagnosed. Within a low threshold psychosomatic intervention an understanding of illness could be established and psychosocial barriers of diabetes therapy were reduced. The patient was able to outline achievable goals of his diabetes treatment and began their successful implementation. Within a stepped-care approach the patient could also be motivated for an inpatient psychosomatic treatment. During the course of treatment the patient experienced a remission from his depressive symptomatology and a notable improvement of metabolic values.
Conclusions: With the help of a close cooperation between diabetes specific and psychotherapeutic treatment in psychosomatic outpatient clinics, patients with high blood glucose levels and comorbid depression can be enabled to gain a better understanding of their illness behavior and change it in their favor.
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