Uncontrolled diabetes mellitus in older adults is frequently approached through pharmacological intensification, including insulin initiation when oral agents fail to meet glycaemic goals. However, psychological factors such as chronic stress, anxiety, and depression may significantly impair glucose regulation and mimic treatment-resistant diabetes.

This case report describes a 70-year-old man with persistently uncontrolled type 2 diabetes (HbA1c 13%) despite maximal dual oral therapy and full adherence to medical and lifestyle recommendations. Using the AlKhathami Five-Step Patient Interview Approach, a structured mental-health integration model for primary care, the family physician identified an underlying moderate–severe anxious-depressive disorder contributing to metabolic dysregulation.

A combined management plan involving non-pharmacological interventions, nutritional support, and SSRI therapy (escit alopram) led to rapid clinical improvement. Within 10 days, the patient developed hypoglycaemia, necessitating the stepwise discontinuation of all antidiabetic medications. Over two months, anxiety and depressive symptoms resolved, sleep and con centration normalised, and HbA1c decreased from 13% to 7% without diabetic drugs.

This case demonstrates the substantial impact of addressing mental-health determinants on chronic-disease outcomes and highlights how the Five-Step Approach enables primary-care physicians to detect hidden psychological distress, prevent un necessary insulin escalation, and achieve meaningful metabolic improvement. Integrating structured mental-health assessment into routine chronic-disease management is essential for improving outcomes in patients with uncontrolled diabetes.