Integrated DCRM
Diabetes, cardiac, renal and metabolic care — taught as one connected system, with an embedded leadership and governance strand no question bank carries.
Reviewed and kept current
Last editorial review: 22 June 2026 · Next scheduled refresh: 1 September 2026.
One system, not four silos
Diabetes, heart failure, chronic kidney disease and obesity are usually taught — and too often managed — as separate problems. In reality they share a single pathophysiology of insulin resistance, inflammation and fibrosis, and the same handful of organ-protective therapies now cut across all of them — a connectedness now formally framed as cardiometabolic multiple long-term conditions in the 2026 Lancet Series.10 The Integrated DCRM CAS teaches that connected reality, anchored to the American Heart Association Cardiovascular–Kidney–Metabolic (CKM) staging model1 — now operationalised as a graded clinical practice guideline in the 2026 AHA/ACC/ADA/ASN CKM guideline7 — and the DCRM 2.0 multispecialty practice recommendations.2
Over ten weeks you move from staging a patient on the CKM continuum, through the metabolic and cardio-renal axes, to running an integrated consultation in multimorbidity — and then to designing and leading a DCRM service where you work. It is the only programme in this space to fuse the full integrated clinical syllabus with a graded, assessed leadership and governance strand.
What's new in this 2025–26 refresh
This cohort is taught to the very latest cornerstone guidance: the first-ever 2026 AHA/ACC/ADA/ASN CKM clinical practice guideline — introducing the PREVENT risk equations and the 4a/4b staging split7; NICE NG28 (type 2 diabetes, Feb 2026), with an SGLT2 inhibitor plus metformin as initial dual therapy for most adults3; NICE NG106 (heart failure, Sep 2025), with upfront quadruple therapy and, for the first time, disease-modifying treatment for HFpEF / HFmrEF8; the 2025 ESC/EAS dyslipidaemia focused update9; and the 2026 Lancet cardiometabolic multiple-long-term-conditions Series.10 The lipid strand is taught to the new 2026 ACC/AHA multisociety dyslipidaemia guideline — explicit LDL-C goals on a PREVENT-based risk framework18 — alongside ESC/EAS 2025 and NICE NG238. A dedicated module on lifestyle, behaviour change and clinic set-up now runs alongside the clinical pillars.
Staging every patient from 0 to 4 — and letting the stage drive management — is the spine of the programme.
Mrs A, 58 — eGFR 48, HbA1c 7.4%, BMI 32, albuminuria rising. Type 2 diabetes and CKD stage 3a, on metformin, losartan and atorvastatin. Decision point: which organ-protective therapies should be sequenced next, in what order, and why? This is the everyday integrated decision the programme builds genuine confidence in.
The same therapies protect across all three axes
Modern organ-protective drug classes were proven in diabetes, then in heart failure, then in chronic kidney disease — the evidence itself dissolved the silos. The CAS teaches them as one toolkit.
Where the four organ-protective pillars are now guideline-indicated across the metabolic, cardiac and renal axes.
By the end of the CAS, you will be able to
Nine modules across four strands
One module per week (Weeks 1–9), each a five-path living lesson plus a live workshop and a confidence-rated knowledge check. Week 10 is integration, capstone and assessment. A dedicated lifestyle, behaviour-change and clinic-set-up module sits alongside the clinical pillars.
Stage
CKM staging & shared pathophysiology
Metabolic
Diabetes · obesity · lipids · MASLD
Cardio-renal
Cardiac axis · CKD · the four pillars
Integrate & lead
Multimorbidity · service design
Module 1 · Foundations of integrated DCRM (CKM staging & risk)
You will be able to: stage a patient on the CKM continuum 0–4 (including 4a/4b), explain the shared insulin-resistance / inflammation / fibrosis axis, and risk-stratify with QRISK3 and the PREVENT equations. Aligned to: 2026 AHA/ACC/ADA/ASN CKM guideline, DCRM 2.0, the 2026 Lancet cardiometabolic-MLTC Series, NICE NG238.
Module 2 · Lifestyle, behaviour change & clinic set-up · New
Deliver structured lifestyle care on Life's Essential 8; use motivational interviewing, SMART target-setting and patient decision aids; and build a proactive cardiometabolic clinic — the GP-coordinated multidisciplinary team, the eGFR + uACR + NT-proBNP case-finding triad, a practical three-visit cycle (Detect & baseline → Activate & titrate → Consolidate & sustain), and digital tools to capture high-risk patients and keep them informed of their progress and results.17 Aligned to: AHA Life's Essential 8, the CRM primary-care call-for-action (Säemann 2025), NICE NG246.
Module 3 · The metabolic core — type 2 diabetes
Select organ-protective glucose-lowering therapy and individualise targets; under NICE NG28 (2026), an SGLT2 inhibitor with metformin is now initial dual therapy for most adults, with a GLP-1 RA first-line in atherosclerotic CVD; metformin's place; targets in frailty. Aligned to: NICE NG28 (Feb 2026), ADA 2026, EASD.
Module 4 · Obesity, incretin therapy & MASLD
Assess adiposity with BMI and waist-to-height ratio; initiate and monitor incretin (GLP-1 / GIP) therapy including dose-escalation, adverse effects and stopping rules; non-invasively stage MASLD with FIB-414; integrate nutrition and bariatric pathways. Aligned to: NICE NG246 (2026) & TA1152, ADA / Obesity Association, EASO.
Module 5 · Lipids & the atherogenic axis
Reach lipid targets through the modern ladder (high-intensity statin → ezetimibe → PCSK9i / inclisiran / bempedoic acid), including upfront combination therapy; ApoB and Lp(a) testing (once per lifetime). Aligned to: the 2026 ACC/AHA multisociety dyslipidaemia guideline,18 the 2025 ESC/EAS dyslipidaemia focused update, NICE NG238.
Module 6 · The cardiac axis — hypertension & heart failure
Manage hypertension and ASCVD; initiate the heart-failure four pillars as upfront quadruple therapy; treat HFpEF / HFmrEF with SGLT2 inhibition and an MRA — the disease-modifying change in NICE NG106 (2025). Aligned to: NICE NG106 (Sep 2025) & NG136, ESC, AHA/ACC.
Module 7 · The cardio-renal axis — CKD
Stage CKD on the KDIGO heat-map; initiate cardiorenal protection (RAS blockade → SGLT2i → finerenone → GLP-1 RA); uACR-guided therapy, sick-day rules and referral thresholds, mapped to the UK funding gates — both dapagliflozin (TA1075) and empagliflozin (TA942) are recommended for CKD, with dapagliflozin generally first-line on current NHS pricing.15 Aligned to: KDIGO 2024, NICE TA877 / TA1075 / TA942, UK Kidney Association.
Module 8 · Integration & evidence
Run an integrated DCRM consultation; sequence the organ-protective classes in multimorbidity; deprescribe; and critically appraise the pivotal evidence, including the 2026 Lancet cardiometabolic-MLTC Series. Aligned to: DCRM 2.0 and all cornerstone bodies.
Module 9 · Leadership, quality & service governance
Design a DCRM / neighbourhood service; run audit and quality improvement (PDSA, driver diagrams); prescribing governance; health economics; mentorship. This strand scaffolds your capstone. Aligned to: NHS England multi-professional framework, CaReMe UK, NICE.
The Acumen Mastery Loop
Every lesson is built as a cycle that moves knowledge into durable, examinable competence — then keeps it current.
Encode
Five-path living lesson.
Retrieve
Low-stakes recall.
Space
Boosters at widening intervals.
Calibrate
Confidence + feedback.
Master
Re-test to proficiency.
Refresh
Kept current.
Built for the extended-scope primary-care team
GPs, prescribing pharmacists and advanced clinical practitioners working in NHS Neighbourhoods and equivalent international settings, who already hold a Level 7 professional qualification and want structured, current, assessed expertise in integrated cardiorenal-metabolic care. The baseline is pitched at Level 7; an optional Professor Mode stretch reaches the doctoral-tier frontier for those who want it.
The renoprotective effect of SGLT2 inhibition involves restoration of tubuloglomerular feedback via macula-densa sodium delivery, reduced glomerular hyperfiltration and attenuation of fibrotic signalling — distinct from, and synergistic with, the natriuretic and cardiometabolic effects. The DAPA-CKD, CREDENCE and EMPA-KIDNEY trials each isolated this signal across overlapping but not identical populations; reconciling them requires careful attention to baseline eGFR strata and albuminuria as a treatment-effect modifier. Professor Mode surfaces exactly this kind of forefront reasoning — as enrichment, never as a hurdle to pass.
Assessed at Level 7; distinction reaches to Level 8
Three elements, completed across Weeks 9–10. The pass standard sits at Level 7 — the optional Professor-Mode material earns distinction, and is never a hurdle to pass.
A balanced blueprint: applied knowledge, a workplace capstone, and a defended presentation.
Your capstone is a workplace asset. Choose the format that fits your setting:
Quality improvement / service set-up
A QI or new-service plan with aims, measures and an implementation route — ready to run where you work.
Critical appraisal
A structured appraisal of recent pivotal evidence, with explicit implications for practice.
Small original project
An audit-with-a-question or protocol, with methodology and ethics considered.
Aligned complex case series
Related complex cases with guideline-referenced management justified throughout.
A credential that doesn't quietly go out of date
Most qualifications begin ageing the day they are conferred. This one is kept current — during the course, and after you graduate.
Every lesson, reference and self-assessment item is current with the latest NICE, ESC, ADA and KDIGO thresholds.
When a cornerstone guideline moves while you are studying, the affected material is reviewed and refreshed, under the Director's clinical sign-off.
The certificate states the period over which its content is warranted current — not just a date of issue.
A short Currency Update micro-lesson with a brief self-assessment re-dates your award's currency — so it keeps pace with practice, indefinitely.
Reviewed and kept current
Beyond a question bank
Reference tools and question banks teach facts. A CAS proves capability — and gives you something to show for it.
The six-block quality framework
A Bologna-aligned scheme governs every programme, end to end.
1 · Curriculum
Mapped to cornerstone guidelines and the relevant professional frameworks.
2 · Assessment
Blueprinted to the learning outcomes; standards held at the award's level.
3 · Faculty
Director-level clinical sign-off on every module and item before it goes live.
4 · Risk governance
An auditable trail; nothing publishes ungated; currency actively maintained.
5 · Student feedback
Structured feedback loops feed programme enhancement each cycle.
6 · Programme monitoring
Ongoing monitoring → enhancement, reviewed on a quarterly cadence.
Awarding & alignment. Awarded by New Vision University (FHEQ Level 7 · 20 UK credits / 10 ECTS); delivered by MD Acumen Ltd. Curriculum-aligned with NICE, ESC/EASD, KDIGO, ADA, AHA/ACC, the RCGP curriculum and the NHS England multi-professional framework. A CAS is an academic award — not a UK degree, GMC registration or specialist registration.
"Curriculum-aligned with" describes explicit content mapping to a body's published guidelines. This page never claims endorsement that has not been confirmed in writing.
Evidence base
The cornerstone guidance the curriculum is mapped to (1–13). Editions current at the last editorial review; links open the issuing body. References 14–17 are programme-faculty publications that extend specific clinical pathways — MASLD, chronic kidney disease and the menopause cardiometabolic transition — and the digital case-finding method taught in the programme. Trial sources cited in lessons are listed in full inside each module.
- Ndumele CE, et al. Cardiovascular–Kidney–Metabolic Health: A Presidential Advisory from the American Heart Association. Circulation. 2023. ahajournals.org
- Handelsman Y, Anderson J, Bakris GL, et al. DCRM 2.0: Multispecialty practice recommendations for the management of diabetes, cardiorenal, and metabolic diseases. Metabolism. 2024;159:155931. metabolismjournal.com
- National Institute for Health and Care Excellence. Type 2 diabetes in adults: management (NG28). Updated Feb 2026. nice.org.uk/guidance/ng28
- Kidney Disease: Improving Global Outcomes. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD. Kidney Int. 2024. kdigo.org
- American Diabetes Association. Standards of Care in Diabetes — 2026. Diabetes Care. 2026;49(Suppl 1). diabetesjournals.org
- European Society of Cardiology. Clinical Practice Guidelines (heart failure; CVD prevention). ESC. escardio.org/Guidelines
- Ndumele CE, Rodriguez F, Dixon DL, et al. 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular–Kidney–Metabolic Syndrome. Circulation. 2026;153. At-a-glance: Panjrath et al., JACC 2026. ahajournals.org
- National Institute for Health and Care Excellence. Chronic heart failure in adults: diagnosis and management (NG106). Updated 3 Sep 2025. nice.org.uk/guidance/ng106
- Mach F, Koskinas KC, Roeters van Lennep JE, et al. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2025;46(42):4359–4378. doi.org/10.1093/eurheartj/ehaf190
- Khunti K et al.; Lim S et al.; Valabhji J et al. Cardiometabolic multiple long-term conditions — a Lancet Series of three papers (epidemiology; mechanisms; interventions). Lancet. 2026. thelancet.com
- National Institute for Health and Care Excellence. Cardiovascular disease: risk assessment and reduction, including lipid modification (NG238). 2023. nice.org.uk/guidance/ng238
- National Institute for Health and Care Excellence. Overweight and obesity management (NG246). Updated 2026. nice.org.uk/guidance/ng246
- National Institute for Health and Care Excellence. Technology appraisals — finerenone (TA877), dapagliflozin (TA1075 · TA679 · TA902), empagliflozin (TA942 · TA929) and semaglutide for CV risk (TA1152). NICE. nice.org.uk
- Robb P, Ravindran N, Varma R. MASLD: a practical diagnostic and treatment pathway. InnovAiT. 2026. (MD Acumen programme faculty.) doi.org/10.1177/17557380261438592
- Varma R, Ravindran N. Stepwise management of chronic kidney disease in primary care. InnovAiT. 2026. (MD Acumen programme faculty.) doi.org/10.1177/17557380261435934
- Ravindran N, Varma R. Cardiometabolic changes at menopause: time for precision menopause treatment. InnovAiT. 2026. (MD Acumen programme faculty.) doi.org/10.1177/17557380261425194
- Mathieson Z, Simmonds-Rosten R, Shuker E, Yang W, Varma R. Digital phenotyping and additive multimorbidity scoring to operationalise very-high-risk secondary prevention in primary care [abstract]. ESC Congress 2026, Munich. Eur Heart J. 2026;47(Suppl 1):abstr 202684246. (MD Acumen programme faculty.)
- Blumenthal RS, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia. Circulation. 2026;153:e1154–e1276. doi.org/10.1161/CIR.0000000000001423
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