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Diabetologie und Stoffwechsel 2020; 15(03): 225-234
DOI: 10.1055/a-1145-3224
Übersicht

Stationäre Therapie des Typ-2-Diabetes

Inpatient Treatment of type 2 diabetes
Juris J. Meier
  Diabetes-Zentrum Bochum/Hattingen, Katholisches Klinikum Bochum, Klinikum der Ruhr-Universität Bochum
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Zusammenfassung

Der überwiegende Teil der Patienten mit Typ-2-Diabetes kann im ambulanten Umfeld (Hausarztpraxen und Diabetes-Schwerpunktpraxen) adäquat und kosteneffektiv behandelt werden. Dennoch erreichen trotz guter ambulanter Versorgungsstrukturen ca. 20–30 % der Patienten keine zufriedenstellende Blutzuckereinstellung. In derartigen Fällen kann eine stationäre Diabetesbehandlung sinnvoll sein. Die Indikationen für eine stationäre Diabetesbehandlung sind in der Nationalen Versorgungsleitlinie Diabetes dargelegt. Besondere Elemente einer stationären Diabetesbehandlung können neben spezifischen Ernährungsinterventionen (z. B. Entlastungstage) spezialisierte Schulungsprogramme, individualisierte Bewegungstherapie ebenso wie eine Anpassung der Insulintherapie bis hin zur intravenösen Insulinbehandlung sein. Eine psychosomatische Mitbetreuung der Patienten erscheint in einer spezialisierten Diabetesbehandlungseinrichtung von essenzieller Bedeutung. Durch die Kombination aus derartigen intensiven Therapiestrategien, einer praktischen Anleitung zur Lebensstilintervention und gruppendynamischen Effekten kann bei vielen Patienten im stationären Rahmen eine deutliche und nachhaltige Verbesserung der Blutzuckereinstellung erzielt werden. Leider ist der Fortbestand derartiger Behandlungseinrichtungen durch die zunehmende Ökonomisierung im Gesundheitssystem und den politisch forcierten Abbau stationärer Versorgungsstrukturen akut gefährdet.

Abstract

The majority of patients with type 2 diabetes can be treated adequately and cost-effectively in outpatient care centers (i. e. by general practitioners or in specialized diabetes outpatient centers). Nevertheless, around 20–30 % of patients do not achieve adequate glycaemic control in those outpatient structures. In such cases inpatient treatment aiming to optimize glycaemic control can be a suitable option. The indications for inpatient treatment of patients with diabetes have been outlined in the national diabetes guideline (“Nationale Versorgungsleitline”). Inpatient care for patients with type 2 diabetes may include specific dietary interventions (e. g. vegetable or oat meal days), specialized training programs, individualized physical therapy as well as the adjustment of insulin therapy, sometimes including transient periods of intravenous insulin therapy. Psychosomatic counselling is a crucial element of inpatient diabetes treatment. Through the combination of intensive pharmacological approaches, practical enforcement of lifestyle intervention and the close interaction amongst affected patients, marked and persistent improvements in glycaemic control can be achieved in a large number of patients undergoing inpatient treatment. Unfortunately, the survival of such inpatients diabetes centers is endangered by the unfavorable reimbursement system and the pressure by politicians and health insurance companies to reduce inpatient treatment capacities.

Schlüsselwörter

Diabetestherapie - Krankenhaus - Insulintherapie - Typ-2-Diabetes

Key words

diabetes treatment - hospital - insulin therapy - type 2 diabetes


Publication History

Received: 21 January 2020

Accepted: 23 March 2020

Article published online:
17 April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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