The last lesson of the module is about honesty regarding scope. The management of T2DM is broader than any curriculum. Naming the boundary is part of competence.
Acute crises. The MoH RK 2022 protocol sends hyperosmolar, hypoglycaemic, ketoacidotic and lactic acidotic comas for emergency hospitalisation. Glucose targets in ACS in the same protocol: before meals 6.1–7.8 mmol/L, acceptable up to 10.0 if strict control is impossible, avoid <6.0. Metformin and glitazones are withdrawn in ACS; SGLT2i and metformin are withheld before contrast. The detailed insulin infusion algorithm is not part of this course.
Pregnancy. Both ADA and the separate MoH RK protocol «Сахарный диабет при беременности» [Diabetes mellitus in pregnancy] follow their own logic of criteria and targets. ADA 2026 Table 2.1 is for non-pregnant individuals. Gestational diabetes is present in the classification but absent from this course's management.
Children and adolescents with T2DM. ADA 2026, Section 14: screening after puberty or from age 10 with overweight/obesity plus a risk factor; autoantibodies so as not to miss type 1. Protocol No. 158 is for adults.
Type 1 diabetes, maturity-onset diabetes of the young (MODY), pancreatogenic diabetes, drug-induced diabetes (steroids, checkpoint inhibitors). The course gave anchors for classification, not management protocols. Insulin pumps, automated insulin delivery (AID), and teplizumab for stage 2 type 1 diabetes are out of scope.
Doses of specific molecules, trade names, "units per kilogram" insulin titration schemes for T2DM. ADA gives 0.4–1.0 U/kg/day as a typical range for type 1 diabetes; the course will not transfer it to T2DM as a starting dose. The drug label and the local formulary are the workplace, not a teaching paragraph.
KDIGO 2026 before final publication. FLOW 2024 can already be cited as an RCT. The draft guideline cannot.
Finally, the morphological triad "atrophy, fibrosis, lipomatosis". In the kidney, fibrosis and tubular atrophy are part of the diabetic injury that the clinician manages through UACR and eGFR. In adipose tissue, ectopic lipid is a mechanism of resistance. As a diagnostic criterion in its own right or as an indication for a separate drug, this triad was not found in ADA 2026, KDIGO 2022 or the MoH RK 2022 protocol. The clinical meaning of diabetic glomerulosclerosis is covered by Module 3 and Lessons 4.1–4.3: you can explain why a person with Kimmelstiel–Wilson nodules on histology (or with their clinical equivalent, A3 + reduced eGFR) is indicated for RAS blockade, an SGLT2 inhibitor and, in the corresponding population, a GLP-1 agonist — and why this follows not from "a picture of fibrosis" but from RCTs in living people with the same risk markers.
If after the course you can look at a teaching case and say: "this is T2DM on two abnormal tests; eye and UACR today; the first line is not metformin-out-of-habit but a class that covers his CKD and heart; the HbA1c target is not 6.0, because in ACCORD people like him died more often" — the learning outcome of the passport has been achieved.