Basal oral therapy (BOT) is a treatment strategy for type 2 diabetes mellitus aimed at maintaining a stable basal (background) blood glucose level using oral glucose-lowering medications. Unlike insulin therapy, BOT allows diabetes control without injections, which is especially important for patients with preserved residual pancreatic function.
Main Goals of BOT
Maintaining target fasting and between-meal glycemic levels.
Reducing the risk of hyperglycemia and its complications.
Minimizing hypoglycemic episodes through the prolonged action of medications.
Simplifying the treatment regimen to improve adherence.
Key Medications Used in BOT
1. Metformin
The primary first-line medication for type 2 diabetes.
Reduces insulin resistance and hepatic glucose production.
Usually taken 1–2 times daily (extended-release forms once daily).
2. DPP-4 Inhibitors (Gliptins)
Sitagliptin, vildagliptin, saxagliptin — enhance insulin secretion in response to meals.
Low risk of hypoglycemia; typically taken once daily.
3. Sulfonylurea Derivatives (Glibenclamide, Gliclazide)
Stimulate the pancreas to secrete insulin.
May cause hypoglycemia and therefore require caution.
4. Thiazolidinediones (Pioglitazone)
Improve tissue sensitivity to insulin.
Used less frequently due to side effects (edema, increased cardiovascular risk).
5. SGLT-2 Inhibitors (Gliflozins)
Empagliflozin, dapagliflozin — promote glucose excretion in the urine.
Also contribute to weight reduction and lower cardiovascular risk.
When Is BOT Used?
In the early stages of diabetes with preserved β-cell function.
In combination with diet and physical activity when metformin monotherapy is insufficient.
As an alternative to insulin in patients without severe metabolic decompensation.
Advantages of BOT
✔ Less invasive (no injections).
✔ Convenient dosing regimen (once or twice daily).
✔ Good control of fasting blood glucose.
✔ Reduced risk of complications with proper drug selection.
Limitations and Risks
Not suitable for advanced stages of diabetes with significant insulin deficiency.
Possible side effects (gastrointestinal disturbances from metformin, hypoglycemia from sulfonylureas).
Requires regular monitoring of blood glucose and HbA1c.
Conclusion
Basal oral therapy is an effective approach for managing type 2 diabetes in its early and moderate stages. However, medication selection must be individualized, taking into account comorbidities and risk factors. As the disease progresses, combination therapy or insulin may become necessary.
Important: BOT should be prescribed by an endocrinologist based on clinical evaluation and laboratory results.