harddiabetesneuropathic painduloxetinemedication adherencecomorbidityintegrated careCKD
A 63-year-old man with type 2 diabetes, diabetic peripheral neuropathy, chronic kidney disease stage 3 (eGFR 42), and obesity (BMI 34) is referred by his endocrinologist for depressive symptoms. He reports 6 months of depressed mood, loss of interest, fatigue, poor concentration, feelings of hopelessness about his health, and hemoglobin A1c that has risen from 7.2% to 9.1% due to decreased medication adherence and dietary neglect. His PHQ-9 score is 18. He reports chronic bilateral foot pain from the neuropathy rated 6 out of 10 that significantly impacts his sleep and daily functioning. He is currently on metformin, lisinopril, and gabapentin 300 mg three times daily with partial pain relief. Which treatment plan best addresses the interconnected nature of his conditions?