CardioDiabetes: Core Competencies for Cardiovascular Clinicians in a Rapidly Evolving Era of Type 2 Diabetes Management

A sea change in the management of diabetes is occurring with the publication of clinical trials showing unequivocal cardiovascular (CV) protection through the use of certain antihyperglycemic agents. This change is similar to the change that occurred when lipid lowering with statins was first shown to have CV benefits, an event necessitating changes in training and the proactive treatment of lipids by CV specialists. As was the case then, many CV specialists currently feel poorly equipped to address diabetes with this new information even though diabetes is common in CV practice. The purpose of this overview is to provide an updated, comprehensive, and evidence-based CV protection plan for patients with type 2 diabetes, intended specifically for cardiologists and vascular medicine specialists. We attempt to elucidate a set of "CardioDiabetes" core competencies by merging the CV-relevant elements of the Diabetes Canada 2018 guidelines within a framework of comprehensive vascular protection as supported by other CV guidelines. We review the rationale for measuring hemoglobin A1C, understanding its use for establishing a diagnosis and for monitoring treatment. We also provide a brief review of the medications most important for a CV specialist to know. We provide useful memory aids and a succinct set of reminders and tips ("ABCDEFR'S") that can serve as a comprehensive checklist in the clinic and help to motivate trainees and clinicians to consult the original guideline source documents to enrich their knowledge and improve treatment in this rapidly changing arena.