Journal of the Royal Society of Medicine

Select all

Editorial
Available accessEditorialFirst published February, 2026pp. 35-35
International medical graduates: a crisis of political choice
Kamran Abbasi
Letter
Available accessLetterFirst published February, 2026pp. 36-36
The value of a good doctor
Nick Ross
Article commentary
Open accessArticle commentaryFirst published February, 2026pp. 37-41
The NHS App should focus on inequalities to improve population health
Anthony A LavertyORCIDClaire ReidySukriti KCORCID
View All
Other
Open accessOtherFirst published February, 2026pp. 42-45
Medical education at the crossroads. Part II: postgraduate training and the future of clinical expertise
Louella VaughanORCIDMartin McKeeORCID
Research article
Open accessResearch articleFirst published February, 2026pp. 46-54
The concentration-dependent protective effects by new generation hypoglycemic agents on delirium,depression,dementia and coma: evidence from a network meta-analysis
Ping-Tao TsengORCIDBing-Yan ZengChih-Wei HsuORCID
View All
Abstract
Objectives:
Emerging evidence suggests that glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose co-transporter 2 (SGLT2) inhibitors may exert neuroprotective effects. However, the comparative efficacy of individual agents remains unclear. This network meta-analysis (NMA) aimed to evaluate the differential impacts of these therapies on the incidence of mental status changes, specifically delirium, depression, dementia and coma.
Design:
A frequentist NMA was conducted using data from randomised controlled trials (RCTs) investigating GLP-1 receptor agonists or SGLT2 inhibitors. The robustness of the findings was verified through a Bayesian NMA framework.
Setting:
This study adopted a confirmatory framework focusing on pre-defined neuropsychiatric adverse outcomes in alignment with Cochrane recommendations.
Participants:
Included trials enrolled individuals without baseline cognitive or psychiatric disorders.
Main outcome measures:
The primary endpoint was the incidence of delirium, depression, dementia or coma during treatment. Secondary endpoints included changes in cognitive performance and drop-out rates.
Results:
A total of 62 RCTs comprising 200,068 participants were included. Among all treatments, only high-dose dapagliflozin (10 mg/day) significantly reduced the occurrence of delirium and depression, particularly in patients with type 2 diabetes. Dulaglutide and liraglutide were the only agents associated with cognitive improvement. No significant benefits were observed for dementia or coma across all agents.
Conclusions:
This analysis highlights agent-specific neuroprotective profiles: SGLT2 inhibitors, especially high-dose dapagliflozin, may mitigate the onset of delirium and depression, while GLP-1 receptor agonists, notably dulaglutide and liraglutide, may enhance cognitive function. These findings warrant consideration in selecting antihyperglycemic therapies for individuals at elevated neuropsychiatric risk.
Trial registration:
PROSPERO CRD42024601021.

The study protocol was approved by the Institutional Review Board of the Tri-Service General Hospital, National Defense Medical Center (TSGHIRB E202516007).
Other
Available accessOtherFirst published February, 2026pp. 55-58
The problematic history of randomised controlled trials Part 2: Hill’s ‘pragmatic’ view of randomisation and its origins
Robert AJ MatthewsORCID
Other
Open accessOtherFirst published February, 2026pp. 59-60
International medical graduates: a workforce at a crossroad?
Richard Antony PowellORCIDMo Al-HaddadORCIDVijay Nayar
View All
Other
Available accessOtherFirst published February, 2026pp. 61-61
From JRSM Open
Obituary
Available accessObituaryFirst published February, 2026pp. 61-61
Death Notices
Calendar
Available accessCalendarFirst published February, 2026pp. 62-62
For more events and to book online,please visit //www.rsm.ac.uk/events

Volume 119, Issue 2, February 2026