y T2D is widely recognized as being associated with an increased risk of cognitive decline and dementia. Although the condition is chronic, its course and associated risks can be significantly modified through effective management. Management of diabetes includes adherence to a healthy diet, regular physical activity, maintenance of a normal body weight and avoidance of tobacco use (124). y Effective glycaemic control and comprehensive cardiovascular risk management are central to diabetes care. They align with broader strategies to reduce the risk of cognitive decline and dementia, and offer wide-ranging benefits for metabolic, vascular and brain health. y In many countries, diabetes prevention and management strategies are already well-integrated into primary care and NCD programmes, providing a strong platform for incorporating dementia risk reduction efforts. Additionally, task-shifting models, such as empowering community health workers to support diabetes education and monitoring, can enhance service delivery in settings with limited health care infrastructure. y Implementation strategies should prioritize the strengthening of health systems, to ensure consistent access to essential medications, blood glucose monitoring tools and adequately trained health care providers, especially in LMIC. In some settings, digital health tools (including mobile health applications, telemedicine and automated reminders) may support aspects of diabetes self-management, such as medication adherence and blood glucose monitoring. y Public health messaging should explicitly address the connection between diabetes, hyperinsulinemia and cognitive decline, raising awareness of the cognitive benefits of glycaemic control among both the general public and health care professionals. Integrating diabetes interventions with broader healthy ageing initiatives may enhance efficiency, maximize health gains and support the long-term sustainability of cognitive health programming. Similarly, integrating brain health considerations into diabetes care pathways may enhance outcomes and increase the perceived value of early intervention. y Rather than relying on a one-size-fits-all approach, glycaemic targets should be individualized, taking into account intrinsic capacity, functional status, comorbidities and life expectancy. In older people, particularly those with significant loss of intrinsic capacity or limited life expectancy, tight glycaemic targets can increase the risk of hypoglycaemia and associated harms (e.g. falls and cognitive decline) without providing meaningful benefits. A person-centred approach is needed, prioritizing safety, quality of life and outcomes that matter to the individual. y Implementation efforts should be culturally tailored to address beliefs, stigma and barriers to diabetes care (including access to healthier food options); also, they should involve community-based strategies to promote health literacy, self-management and patient engagement.

Management of diabetes should be offered to all adults with diabetes, in line with WHO guidance. Clinical practice: y HEARTS D: diagnosis and management of type 2 diabetes (36) Service delivery and care pathways: y WHO package of essential noncommunicable (PEN) disease interventions for primary health care (11) Public health and policy: y The WHO Global Diabetes Compact (37) y Global action plan for the prevention and control of noncommunicable diseases 2013–2020 (35) y Tackling NCDs: best buys and other recommended interventions for the prevention and control of noncommunicable diseases (12)