A third-year student sees, for the first time, a lab report showing glycated haemoglobin (HbA1c) of 7.2% in a person with no thirst and no polyuria. The question is not "what is this percentage". The question is whether this can already be called diabetes mellitus, whether a second measurement is needed, and what follows from it for the eyes, the kidneys and the choice of the first drug. The course is built around this fork.
Type 2 diabetes mellitus (T2DM) is a heterogeneous disease in which adequate insulin secretion by β-cells is progressively lost against a background of insulin resistance (reduced tissue sensitivity to insulin). This is how the ADA defines it in the Standards of Care in Diabetes—2026, Section 2 (Diabetes Care 2026;49(Suppl 1):S27–S49). The 2022 Clinical Protocol of the Ministry of Health of the Republic of Kazakhstan (MoH RK) puts it similarly: "progressive impairment of insulin secretion against a background of insulin resistance". It is not "diabetes of the elderly" and not "non-insulin-dependent diabetes": both labels are outdated, because the disease occurs at any age and insulin is often needed in it.
The course is addressed to 3rd–5th-year students and first-year residents. The learning outcome is concrete. After it you:
- formulate the diagnosis according to the current ADA 2026 criteria and reconcile them with the MoH RK 2022 protocol;
- explain the mechanism of insulin resistance and its link to micro- and macrovascular complications — not as the metaphor "sugar damages vessels", but as a chain with a named study population;
- build a plan for screening complications (kidney, eye, nerve, foot, cardiovascular risk);
- explain what determines the choice of first-line therapy: not the name of a "default" drug, but the comorbidity map.
How the programme is organised. Four content modules: epidemiology and pathogenesis; diagnosis; complications; principles of management. Each module has five lessons and an eight-question checkpoint. The final exam has 25 questions, a pass threshold of 75%, and two attempts. At least one third of the questions are analysis of a generalised teaching case. A case in this course is always a teaching construct: no surname, no date of birth, no recognisable history from a specific clinic.
What the course does not cover is not a footnote at the end — it is a condition for reading it honestly.
It does not replace the management protocol for type 1 diabetes mellitus, gestational diabetes or monogenic forms. The classification is needed so as not to confuse them, but insulin pump management, autoantibody screening in a child and the obstetric protocol are not covered here as disciplines in their own right.
It does not teach intensive care of diabetic comas. The MoH RK 2022 protocol explicitly lists hyperosmolar, hypoglycaemic, ketoacidotic and lactic acidotic comas as indications for emergency hospitalisation; the detailed resuscitation algorithm lives in a separate protocol, «Диабетические комы» [Diabetic comas].
It does not give "one-size-fits-all" doses and does not write an individual prescription. The metformin dose at a specific glomerular filtration rate (GFR), insulin titration, and the choice between molecules within a class belong to clinical work with the drug label and a living patient. Where the source names a threshold (for example, do not start metformin at an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m²), the threshold will be named. Where there is no source, it will say "not found".
It does not cover paediatric T2DM in a separate module. ADA 2026 places children and adolescents in Section 14; the MoH RK 2022 protocol is written for adults. The age boundary of the adult protocol is its users: "adults".
The clinical basis of the course is stated explicitly, because thresholds change with each edition. As of the build date (September 2026), the following are in force:
- ADA Standards of Care in Diabetes—2026, annual revision, Diabetes Care 2026;49(Supplement_1);
- KDIGO 2022 Clinical Practice Guideline for Diabetes Management in CKD (Kidney Int. 2022;102(5S):S1–S127);
- MoH RK clinical protocol «Сахарный диабет 2 типа» [Type 2 diabetes mellitus], Joint Commission on the Quality of Medical Services (JCQMS) [рус.: ОККМУ], 04.03.2022, protocol No. 158.
Where the documents diverge, the course shows the divergence rather than "averaging" it. A typical example: the threshold for starting a sodium-glucose cotransporter 2 (SGLT2) inhibitor at reduced GFR is lower in KDIGO 2022 and ADA 2026 than in the wording of the MoH RK 2022 protocol. This is not an error in one of the texts — it is a different year of the evidence base. The student must be able to name both thresholds and say which document they are citing.
One more reading rule. An observational association ("people with high HbA1c have more myocardial infarctions") is not restated as an effect ("lower HbA1c — prevent myocardial infarction"). An effect requires interventions: RCTs or meta-analyses of RCTs, with a named population. UKPDS 33 reduced microvascular outcomes in newly diagnosed T2DM; EMPA-REG OUTCOME reduced cardiovascular death in people with T2DM and already established cardiovascular disease. These are different populations and different claims.
From here the course moves from number to mechanism, from mechanism to criterion, from criterion to complication, and from complication to the choice of first line. In this course, theory never begins without a clinical question.