Complications, Comorbidities, and Cardiometabolic Risk Reduction
What the exam expects
Candidates must screen for and manage microvascular and macrovascular complications, and reduce cardiometabolic risk beyond glucose. Know screening intervals for retinopathy, nephropathy, neuropathy, and foot disease. Understand blood pressure and lipid targets, statin use, smoking cessation, and vaccination.
Concepts to master
- Diabetic kidney disease: albuminuria and estimated glomerular filtration rate monitoring, ACE inhibitor or ARB use, and SGLT2 inhibitor benefit.
- Retinopathy screening and referral timing.
- Peripheral and autonomic neuropathy assessment, including foot exam and monofilament testing.
- Cardiovascular risk reduction and heart failure management.
- Hypoglycemia as a safety complication, especially in older adults.
- Comorbidity clusters: obesity, sleep apnea, fatty liver disease, depression.
Traps
Items may reward treating glucose alone while ignoring blood pressure or lipids. Another trap is using an ACE inhibitor and ARB together, or missing that eGFR decline requires dose adjustment. Watch for foot exam questions where a visual inspection alone is considered sufficient.
Rule of thumb
At every visit, address the ABCs plus smoking: A1C, blood pressure, cholesterol, and cessation, along with kidney and foot screening at recommended intervals.
Worked example
A patient with type 2 diabetes has albuminuria and hypertension. The plan includes an ACE inhibitor or ARB, an SGLT2 inhibitor for kidney protection, blood pressure control, and periodic monitoring of potassium and kidney function.