A 45 year old man with type 2 diabetes is referred to a CDCES with a persistently elevated A1c (9.4%). He has missed multiple follow-up appointments and reports inconsistent medication use.
During the visit, he shares that he recently lost his job, is staying intermittently with friends, and often skips meals due to limited food access. He reports feeling “constantly stressed” and “burned out” with diabetes management.
A Diabetes Distress Scale (DDS) score indicates moderate distress, and a PHQ-9 score is 4 (minimal depressive symptoms). He denies suicidal ideation.
Which of the following is the most appropriate next step for the CDCES?
- A. Refer immediately to a psychiatrist for evaluation of depression and initiate pharmacologic treatment.
- B. Provide structured problem-solving support, address social needs, and coordinate with appropriate team members.
- C. Delay intervention until glycemia improves, then reassess psychosocial concerns.
- D. Focus primarily on intensifying glucose monitoring and medication adherence strategies.
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