Department of Medicine, People's College of Medical Sciences, Bhopal, India.
Department of Endocrinology, Bharti Hospital, Karnal, India.
J Pak Med Assoc. 2020 Mar;70(3):547-551.
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.
口服降糖药失效（OAD failure）是临床实践中经常使用的术语。然而，对于这个术语并没有一个普遍接受的定义。本通讯描述了 OAD 失效的概念，并为其制定了一个工作定义。该定义以耐药性高血压为例，评估了各种类型的 OAD、生活方式改变、高血糖的继发原因和糖尿病实践中的症状在其中的相对作用。它利用这些概念构建了一个 OAD 失效的定义：OAD 失效定义为一种临床情况，即尽管同时使用了三种不同类别的最佳剂量的口服降血糖药物，其中一种应为二甲双胍，第二种最好是磺酰脲类药物，同时遵循了适当的饮食和运动，但 HbA1c 仍高于目标值，并且排除了导致高血糖的合并症。在使用三联 OAD 治疗的情况下，即使存在胰岛素分泌不足（渗透性症状、体重减轻）和血糖控制不佳（血浆葡萄糖＞300mg％）的症状，也可以定义为 OAD 失效。
