Frequency of First Generic Drug Approvals With “Skinny Labels” in the United States

sidered quality of life and comorbidities. Although those with advanced dementia were less likely to have had an emergency department visit for hypoglycemia, a potentially critical moment for intervention, this may reflect their relative inability to express the symptoms of dizziness, headaches, or other hypoglycemia-related outcomes. Moreover, delirium and metabolic encephalopathies facilitated by recurrent hypoglycemia, electrolyte derangements, and subtle brain hypoperfusion are difficult to track accurately over time. It is not known whether repeated dips in blood glucose levels may worsen dementia, although prior work has found that tight glycemic control does not seem to improve cognitive function. reater attention is needed to prevent diabetes-related treatment complications. Dementia is increasingly common among aging patients with diabetes and other vascular risk factors, and clinicians should more actively deprescribe sulfonylureas in patients older than 70 years. Regular reevaluations that consider changes in comorbidity burden, cognitive function, quality of life, and treatment goals should aim to reduce polypharmacy and liberalize glycemic treatment targets among patients with advanced cognitive impairment. As patients age, the benefits of treatment should be questioned, and the increasing risks recognized, especially for older, cognitively impaired patients with diabetes and limited life expectancy.