Oral antidiabetic failure (OAD failure) is a term which is used frequently in clinical practice. There is no uniformly accepted definition, however, for this term. This communication describes the concept of OAD failure, and develops a working definition for the same. The definition uses resistant hypertension as an example, and assesses the relative role of various classes of OADs, lifestyle modification, secondary causes of hyperglycaemia, and symptomatology in diabetes praxis. It utilizes these concepts to build a definition of OAD failure which states: OAD failure is defined as a clinical situation where HbA1c remains above goal, despite concurrent use of optimum dose of three oral glucose lowering drugs of different classes, one of which should be metformin and the second, preferably a sulfonylurea, provided adequate diet and exercise have been followed, and comorbid conditions causing hyperglycaemia ruled out. OAD failure may also be defined in patients who have symptoms suggestive of insulinopenia (osmotic symptoms, weight loss), and uncontrolled glycaemia (plasma glucose> 300mg %), in spite of using triple OAD therapy.
Keywords: Clinical inertia, diabetes, HbA1c, insulin, insulin initiation, metformin, sulfonylurea Approach.