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Re: Medications for adults with type 2 diabetes: a living systematic review and network metaThe Immunity Gap Behind Lost EliminationSpain to reduce Madrid-Seville trains until European management system installedSecurity guard in Bohol ignores injury, found dead the next dayQC aligns heat-related class suspension rules with DepEd, Marcos EODepEd secures discounted Apple laptops for public educatorsRe: Medications for adults with type 2 diabetes: a living systematic review and network metaThe Immunity Gap Behind Lost EliminationSpain to reduce Madrid-Seville trains until European management system installedSecurity guard in Bohol ignores injury, found dead the next dayQC aligns heat-related class suspension rules with DepEd, Marcos EODepEd secures discounted Apple laptops for public educators
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Health1h ago
Re: Medications for adults with type 2 diabetes: a living systematic review and network meta
Agreement: I Agree Body: Dear Editor, Nong and colleagues’ living systematic review and network meta-analysis provides a timely synthesis of evidence on glucose-lowering therapies and dementia. Their finding that glucagon-like peptide-1 receptor agonists (GLP-1RAs) may reduce dementia risk, although with low certainty (OR 0.92, 95% CI 0.83–1.02), while evidence for other drug classes remains very uncertain, highlights an important evidence gap rather than demonstrating an absence of benefit.[1] This uncertainty is particularly relevant because dementia develops over many years, whereas diabetes trials generally focus on shorter-term metabolic, cardiovascular and renal outcomes. Although the review included 23 trial comparisons involving 161,179 participants and 1,933 dementia events, the median follow-up across its 869 included trials was only six months, limiting conclusions about long-term cognitive outcomes.[1] Emerging evidence suggests that cognitive outcomes may depend on factors beyond mean HbA1c. In a cohort of 171,964 people with type 2 diabetes, greater visit-to-visit HbA1c variability was associated with increased dementia risk (adjusted HR 1.15, 95% CI 1.12–1.17), including among those with mean HbA1c below 6% or between 6% and 8%.[2] A meta-analysis involving 577,592 people with diabetes reported a similar association, although observational findings cannot establish causality.[3] Similarly, a Hong Kong cohort of 55,618 people with type 2 diabetes found that participation in a multidisciplinary diabetes-management programme was associated with lower risks of all-cause dementia, Alzheimer’s disease and vascular dementia. Risk was lowest among participants with mean HbA1c of 6.5–7.5%, with both higher and lower levels associated with greater risk.[4] While these findings do not establish an optimal HbA1c target for dementia prevention, they highlight the need to understand how glycaemic control, treatment intensity and broader care influence cognitive health. Evidence concerning individual drug classes also remains unsettled. A meta-analysis of randomised trials found no significant overall reduction in dementia or cognitive impairment with cardioprotective glucose-lowering therapies, although GLP-1RAs were associated with lower risk (OR 0.55, 95% CI 0.35–0.86); SGLT2 inhibitors showed no such association.[5] Differences in outcome definitions, follow-up duration and the inclusion of cognitive impairment alongside dementia may partly explain these contrasting estimates. The evidence gap is particularly important in low- and middle-income countries (LMICs), including India, where diabetes and other modifiable dementia risk factors are prevalent, but long-term cognitive evidence remains geographically uneven. Indian population-level estimates indicate considerable potential for dementia prevention through addressing modifiable risk factors, including diabetes and vascular risks.[7] However, potential benefits of newer therapies must be considered alongside affordability, equitable access and treatment sustainability. Future trials and real-world studies should include diverse LMIC populations, employ culturally and linguistically appropriate cognitive assessments, and account for hypoglycaemia, glycaemic variability, competing mortality and differences in healthcare access. Integrating cognitive assessments into existing diabetes and primary-care programmes could generate locally relevant evidence without requiring separate dementia surveillance infrastructure. These considerations support including cognitive decline and dementia as prespecified long-term outcomes in future diabetes trials, rather than relying primarily on post hoc analyses of administrative diagnoses. Tracking cognitive trajectories and dementia subtypes alongside hypoglycaemia, glycaemic variability and conventional metabolic and cardiovascular outcomes would help establish whether newer therapies influence dementia risk or whether observed associations reflect broader improvements in vascular and metabolic health. The 2024 Lancet Commission places diabetes, hypertension, obesity and other metabolic and vascular exposures within a life-course approach to dementia prevention.[6] Updated WHO guidance similarly addresses risk reduction for cognitive decline and dementia, although evidence for specific preventive interventions remains uncertain.[8] Ultimately, the key question is whether improved management of these risk factors translates into fewer dementia cases. The BMJ living-review approach provides a valuable framework for updating the evidence as longer-term data emerge. Dr Pradeep Paul George, Madras Diabetes Research Foundation, Gopalapuram, Chennai. Dr RM Anjana, Dr. Mohan's Diabetes Specialities Centre – Gopalapuram, Chennai, Madras Diabetes Research Foundation, Gopalapuram, Chennai. Dr Murali Krishna, Centre for Brain Research, Indian Institute of Science, Bangalore, India. Dr V Mohan, Dr. Mohan's Diabetes Specialities Centre – Gopalapuram, Chennai, Madras Diabetes Research Foundation, Gopalapuram, Chennai. References 1. Nong K, Jeppesen BT, Shi Q, et al. Medications for adults with type 2 diabetes: a living systematic review and network meta-analysis. BMJ. 2025 Aug 14;390:e083039. doi: 10.1136/bmj-2024-083039. 2. Moran C, Whitmer RA, Dove Z, et al. HbA1c variability associated with dementia risk in people with type 2 diabetes. Alzheimers Dement. 2024 Aug;20(8):5561–5569. doi: 10.1002/alz.14066. Epub 2024 Jul 3. 3. Song J, Bai H, Xu H, Xing Y, Chen S. HbA1c variability and the risk of dementia in patients with diabetes: a meta-analysis. Int J Clin Pract. 2022;2022:7706330. doi: 10.1155/2022/7706330. 4. Wang K, Zhao S, Lee EK, et al. Risk of dementia among patients with diabetes in a multidisciplinary, primary care management program. JAMA Netw Open. 2024;7(2):e2355733. doi: 10.1001/jamanetworkopen.2023.55733. 5. Seminer A, Mulihano A, O’Brien C, et al. Cardioprotective glucose-lowering agents and dementia risk: a systematic review and meta-analysis. JAMA Neurol. 2025;82(5):450–460. doi: 10.1001/jamaneurol.2025.0360. 6. Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet. 2024;404(10452):572–628. doi: 10.1016/S0140-6736(24)01296-0. 7. Angrisani M, Nichols E, Meijer E, et al. Modifiable risk factors for dementia in India: a cross-sectional study revisiting estimates and reassessing prevention potential and priorities. BMJ Public Health. 2024;2(2):e001362. doi: 10.1136/bmjph-2024-001362. 8. World Health Organization. Risk reduction of cognitive decline and dementia: WHO guidelines. 2nd ed. Geneva: World Health Organization; 2026. ISBN: 978-92-4-012355-7. Competing Interests: No competing interests No competing Interests: Yes The following competing Interests: Electronic Publication Date: Tuesday, November 3, 2026 - 09:27 AI use: No, I have not used AI Highwire Comment Subject: Workflow State: Released Full Title: Re: Medications for adults with type 2 diabetes: a living systematic review and network meta-analysis Highwire Comment Response to: Check this box if you would like your letter to appear anonymously:: Last Name: George First name and middle initial: Pradeep Paul Email: drpradeep@mrf.in Address: No. 4, Conran Smith Road, Gopalapuram, Chennai – 600 086, Tamil Nadu, India Occupation: Epidemiologist Other Authors: Dr RM Anjana, Dr Murali Krishna, Dr V Mohan Affiliation: Madras Diabetes Research Foundation, Chennai BMJ: Additional Article Info: Rapid response
BBmj
Health1h ago
The Immunity Gap Behind Lost Elimination
Agreement: I Agree Body: Dear Editor Wilson and colleagues' 49-week investigation of 2377 cases, which cost Canada its measles elimination status, is the most complete account yet of how elimination can be lost in a high-income setting, and it advances the field on several fronts. Its central contribution is conceptual: by showing that nine in ten cases arose in historically under-vaccinated communities and three quarters in people aged 19 years or younger, with only limited spillover, it reframes elimination as a distribution problem rather than a threshold - a reframing with direct operational value, because it indicates where catch-up should be concentrated. Three extensions follow naturally from the study's design. First, the case series is detailed enough to anchor immunity measurement rather than merely describe it: an 89.2% unvaccinated case fraction can be read alongside seroprevalence or coverage for the same communities - accepting the known limitations of serosurveys - so that an observed outbreak yields a quantified immunity gap and identifies which networks to prioritize. Second, the genomic finding is the paper's strongest signal and the clearest template for regional surveillance: a novel N450 sequence, later detected in the United States, Mexico and the Netherlands and designated a WHO named strain, shows how case-linked sequencing can trace cross-border spread in near real time, as the whole-genome approach applied to the 2025 Texas outbreak shows could become routine. Third, because the same strain crossed three borders, the report makes a persuasive case that elimination is best governed as a regional commons, with verification tied to subnational immunity metrics. Read together, the study does more than document a setback: it supplies an actionable map of where immunity is missing and a genomic early-warning model. The natural next step is to pair subnational immunity-gap metrics with case-linked genomic surveillance, so that the next chain is anticipated where it begins rather than reconstructed after the fact. No competing Interests: Yes The following competing Interests: Electronic Publication Date: Tuesday, November 3, 2026 - 07:58 AI use: No, I have not used AI Highwire Comment Subject: Impact of a large measles outbreak associated with transmission in the Americas and Canada’s loss of measles elimination status: descriptive cohort study Workflow State: Released Full Title: The Immunity Gap Behind Lost Elimination Highwire Comment Response to: Impact of a large measles outbreak associated with transmission in the Americas and Canada’s loss of measles elimination status: descriptive cohort study Check this box if you would like your letter to appear anonymously:: Last Name: Cong First name and middle initial: Sun Email: suncong@sysucc.org.cn Address: State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China Occupation: Professor Affiliation: BMJ: Additional Article Info: Rapid response
BBmj
Health1h ago
Top 10 best hair transplant clinics in Turkey Verified Google Ratings (2026)
Disclaimer: This paid article is intended for US audiences. Losing your hair can change how you feel about yourself, sometimes more than you’d care to admit. And once you start researching hair transplant Turkey options, it doesn’t take long to understand why so many people end up looking toward Istanbul. The city has become a
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Health1h ago
PhilHealth warns public against scammers impersonating CEO for money
MANILA, Philippines — The Philippine Health Insurance Corporation (PhilHealth) on Tuesday warned the public against individuals impersonating its Chief Executive Officer, Beverly Lorraine Ho, to solicit money and conduct unauthorized transactions. In an advisory, PhilHealth said that social media posts, emails, or messages requesting money or donations in the name of the agency or its
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