Therapeutic Research

Abstract

Basal –supported oral therapy（BOT） is recommended in several guidelines as initial insulin therapy in patients with type 2 diabetes mellitus. Titration of the basal insulin dose is indispensable for successful glycemic control, and main medical societies in the world recommended that dose adjustment to be done every few days, but adequate titration has not been achieved in real world settings in Japan. Without timely titration, the advantages of BOT（i.e., simple and convenient method with good treatment efficacy） are diminished. Experience of hypoglycemia may affect the attitude/behavior of patients to insulin treatment. Starting with a relatively low dose that does not trigger hypoglycemia helps to reassure patients who are anxious about insulin therapy. In this regard, however, timely titration is essential to achieve the target glycemic level. A basal insulin dose with a better profile compared with presently available ones, an algorithm for titration of the basal insulin dose, and support for patients/hospital staff are important to promote timely initiation and titration in everyday clinical settings.