Sedentary Lifestyle, Depression, and Rising A1c: A Case Study in a Middle-Aged Man 

 

Abstract: 

Musculoskeletal pain is often reported among patients with type II diabetes, where it can interfere with self management, daily functioning, and overall metabolic control. This case is presented to highlight how lifestyle, psychosocial, and behavior factors may complicate glycemic management and contribute to poor diabetes outcome. We describe a 57-year-old male with uncontrolled type II diabetes, depression, and hypertension presenting with shoulder pain from activity and work related wrist pain. Although initially concerned that his symptoms may be cardiac related, clinical assessment suggested mechanical shoulder strain related to dog walking and potential carpal tunnel syndrome associated with repetitive keyboard use. His case reveals the adverse effects that sedentary habits, limited physical activity, and a carbohydrate rich diet can have on glycemic control, reflected by a fasting glucose of 160 mg/dL and an A1c of 9.0% despite medications. Furthermore, this patient’s challenges highlight the need to include lifestyle education, nutritional counseling, exercise guidance, and behavioral strategies into diabetes care. Evidence-based guidelines emphasize individualized glycemic goals, structured nutrition therapy, and gradual increases in physical activity. Ultimately, recognizing musculoskeletal limitations and psychosocial barriers and addressing these factors is essential for achieving optimal patient outcomes.

 

Introduction: 

Type II diabetes mellitus is a chronic metabolic disorder characterized by insulin resistance and progressive B-cell dysfunction, leading to hyperglycemia and long term cardiovascular, renal, and neurologic complications. It requires long term management focusing on glycemic control, lifestyle modifications and cardiovascular risk reduction. Many patients struggle to meet the recommended goals when dietary habits, lack of physical activity, and depression interfere with effective self management.

 

Case Presentation: 

A 57-year-old male accountant with a history of type II diabetes mellitus, moderate to severe depression, and hypertension is partially controlled with medications. He lives with his wife and dog, works a sedentary job, and engages in minimal physical activity.

 

The patient presents with left shoulder and upper arm pain during dog walking, as well as left wrist pain during computer use. The discomfort is limited and no symptoms of chest pain, shortness of breath, palpitations are seen. His left wrist pain is localized to the ventral surface of the wrist, worsening throughout the workday, and it follows numbness and tingling in the thumb and first finger, occasionally waking him at night, but improves on weekends. He has been taking ibuprofen 400 mg with partial relief, reducing his wrist pain from 6/10 to 3/10. He notes prolonged periods of sitting at his computer with little movement and no adequate exercise. Additionally, he reports low motivation, fatigue, and a diet high in carbohydrates and sweets. Recent glucometer readings have been 180-200 mg/dL, with fasting glucose of 160 mg/dL and an A1c of 9.0%. Despite recommendations, he remains hesitant to start insulin therapy.

 

Vitals showed blood pressure of 142/86 mmHg along with normal heart and respiratory rate. He is 5’11.5” tall, weighs 190 pounds, and has a waist circumference of 43 inches. Medications include metformin 500 mg twice daily, glyburide 5 mg twice daily, paroxetine 20 mg twice daily, and enalapril 5 mg twice daily. His family history is notable for type II diabetes and prostate cancer in his father, hypertension and stroke in his mother, and macular degeneration in his brother. Diet consists of limited vegetables and lean proteins, and he remains inactive apart from walking his pet.

 

As per current guidelines, recommended preventive care includes annual screening for diabetic eye disease, nephropathy, diabetic foot complications, and lipid disorders. Blood pressure should be acquired at each visit, with the goal of <130/80 mmHg if tolerated with treatment. Depression screening should occur routinely as high prevalence rates exist among diabetics. Furthermore, vaccinations due include Influenza, COVID-19, Pneumococcal, Tdap/Td, Shringrix, and Hepatitis B. He also requires colorectal cancer screening and prostate cancer screening, given his father’s history.

 

Diet and exercise plan can be initiated by shifting from carbohydrates to higher protein, fiber meals including eggs, yogurt, and whole grains, along with replacing chips and sweets with nuts or fruits. Limiting sweets to special occasions or healthier snack options can enhance adherence greatly, with the end goal of an A1c below 7% to lower the risk for microvascular complications. Additionally, 150 minutes of moderate exercise per week and a gradual 10 minute walks after meals progressing to 30 minutes aligns with guidelines. Light resistance training twice weekly and workstation modifications can greatly reduce functional limitations. Furthermore, low motivation may limit change, so using empathy and setting small goals is key. Questions that may be asked include the following:

 

• Is there a short 5 to 10 minute activity you enjoy that can be done daily?
• What is one simple change that you can make to your eating habits?

 

To help reinforce these changes, referrals to diabetes educators or support programs may also help him build confidence and checking in routinely about his mood and progress is also recommended.

 

Discussion: 

This case aligns with existing literature on challenges diabetic patients face, but stands out because functional deterioration is evident early through fatigue, poor sleep, low activity tolerance and musculoskeletal symptoms that appear alongside his rising glucose levels. It suggests that small shifts in daily routines may signal declining diabetes control earlier than standard clinical markers. Nevertheless, clinicians must recognize and address these early changes with compassion and provide supportive care to improve engagement and prevent further decline. Key take-home messages are as follows:

 

• Prioritize early lifestyle guidance to improve glycemic control and reduce long term complications.
• Psychosocial factors meaningfully influence diabetes outcomes and should be explored during clinical visits.

 

Conclusion: 

Early changes in routine, motivation, and physical comfort can quietly disrupt diabetes management long before complications appear. The study highlights the need for clinicians to look beyond laboratory values and recognize behavioral patterns, mood symptoms, and functional changes as meaningful clinical indications. In essence, it shows that supporting patients in their lifestyle changes and emotional health is just as critical as adjusting medications in preventing long term diabetes complications.

 

 

 

References:

[1] Wexler, D. J. (2025). Overview of general medical care in nonpregnant adults with diabetes mellitus. In D. M. Nathan (Section Ed.) & Z. Hussain & K. Rubinow (Deputy Eds.), UpToDate. Retrieved December 3, 2025, from https://www.uptodate.com/contents/overview-of-general-medical-care-in-nonpregnant-adults-with-diabetes-mellitus

[2] Delahanty, L. M., & Maruthur, I. M. (2025). Medical nutrition therapy for type 2 diabetes mellitus. In D. M. Nathan & D. Seres (Section Eds.) & Z. Hussain & K. Rubinow (Deputy Eds.), UpToDate. Retrieved December 3, 2025, from https://www.uptodate.com/contents/medical-nutrition-therapy-for-type-2-diabetes-mellitus

[3] Wexler, D. J. (n.d.). Initial management of hyperglycemia in adults with type 2 diabetes mellitus. In D. M. Nathan (Section Ed.), & Z. Hussain & K. Rubinow (Deputy Eds.), UpToDate. Retrieved December 3, 2025, from https://www.uptodate.com/contents/initial-management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus

[4] Robertson, R. P., & Udler, M. S. (2025). Pathogenesis of type 2 diabetes mellitus. In D. M. Nathan (Section Ed.) & K. Rubinow (Deputy Ed.), UpToDate. Retrieved December 3, 2025, from https://www.uptodate.com/contents/pathogenesis-of-type-2-diabetes-mellitus