Summary of the 7-T concept of basal early strategies to maximize HbA1c reduction with oral therapy

Treatment initiation	Begin basal insulin at 10 U/day or 0.1–0.2 U/kg/day, depending on the degree of hyperglycemia
Timing	Basal insulin should be injected at the appropriate time (usually bedtime)
	Under some circumstances, it may be administered at the same time daily, in the morning or afternoon
Transportation and storage	Insulin vials, cartridges, or pens may be kept at room temperature for 28 days to 1 month, depending on the type of insulin. However, in settings where the temperatures can be above 30 °C or below 2 °C, it is not advisable to leave the vials at room temperature
	The cold chain should be maintained during the transportation of the vials or cartridges of insulin
Technique of administration	Basal insulin, if injected into intramuscular space, may act like rapid-acting insulin
	The abdomen is the preferred site for soluble human insulin as it leads to the fastest absorption
Targets for titration	The initial basal insulin dose may be started at 10 U/day or 0.1–0.2 U/kg/day, depending on the degree of hyperglycemia
	Titration, in steps of 2–4 units, should be initially performed once to twice a week until optimal control is achieved
Tablets	In combination with basal insulin:
	- Metformin: Preferred initial therapy (with HbA1c ≥ 6.5% and FPG level ≥ 126 mg/dL)
	- Sulfonylureas: Preferred agents where cost is a limiting factor. Begin at a low dose, but dosage can be increased at intervals of 2–4 weeks until the glycemic target is reached. Pioglitazone or rosiglitazone help reduce PPG levels
	- AGIs: Used as the first-line treatment in patients with controlled basal glucose concentrations and marked postprandial hyperglycemia
	- DPP-4 inhibitors: Weight neutral, not associated with an increased risk of hypoglycemia, and lowers PPG levels by decelerating gastric emptying, thus helping patients with T2DM achieve their target HbA1c levels
	- SGLT2 inhibitors: Possess potential benefits in terms of renoprotection, cardiovascular risk reduction, weight loss, blood pressure reduction, and improvements in glycemic control without the weight gain and hypoglycemic risks associated with insulin therapy
	- GLP-1 receptor agonists: Basal insulin plus GLP-1 receptor agonists are associated with less hypoglycemia and with weight loss instead of weight gain, but they may be less tolerable and cost more
Tools for monitoring and troubleshooting	Once-daily FPG and strategic 2-h PPG are acceptable SMBG strategies for BOT
	Hypoglycemia Awareness Questionnaire may be used by patients to monitor glucose level changes in consultation with their healthcare providers
	Online apps, such as mySugr, OnTrack Diabetes, MyFitnessPal, and Diabeto, can be used by patients to manage diabetes and insulin dosing