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CASE SCENARIO ,,, A 48 year old Hispanic woman presents to your office complaining of persistent swelling of her feet and ankles, so much so that she cannot put on her shoes. She first noticed mild ankle swelling approximately 2-3 months ago. She borrowed a few diuretic pills from a friend; the pills seemed to help, but now she has run out. She also reports that she gained 20-25 lb over the last few months, despite regular exercise and trying to adhere to a healthy diet. Her medical history is significant for type 2 diabetes, for which she takes a sulfonylurea agent. She neither sees a doctor regularly nor monitors her blood glucose at home. She denies dysuria, urinary frequency, or urgency, but she does report that her urine has appeared foamy. She had no fever, joint pain, skin rashes, or gastrointestinal symptoms. Her physical examination is significant for mild periorbital edema, multiple hard exudates, and dot hemorrhages on funduscopic examination, and pitting edema of her hands, feet, and legs. Her chest is clear, her heart rhythm is regular without murmurs, and her abdominal examination is benign. She has diminished sensation to light touch in her feet and legs to mid-calf. A urine dipstick performed in the office shows 2+ glucose, 3+ protein, and negative leukocyte esterase, nitrates, and blood.

• What is the most likely diagnosis?
• What is the best intervention to slow the disease progression?