Fig. 1.

Recommended treat-to-target algorithm for the initiation and titration of basal insulin in basal insulin supported oral antidiabetic therapy (BOT). ^$Basal insulin analogues such as glargine and detemir are associated with a lower risk of hypoglycemia and are preferred. Where cost is a constraint, neutral protamine Hagedorn (NPH) can be used. In individuals at high risk of hypoglycemia, longer-acting insulin analogues such as degludec or Gla-300 should be considered. ^*While once-daily basal insulin is preferably administered at bedtime, it can be administered any time of the day depending on the sociocultural circumstances. NPH and detemir may have to be administered twice a day in some individuals