目的：強化療法で良好な血糖コントロールが得られた肥満2型糖尿病患者2例の報告を通し、SGLT2阻害剤を用いたBOTへの切り替えの有用性、およびその際のインスリン減量方法を提案する。

　症例：61歳女性、および37歳男性の肥満2型糖尿病患者2症例に対し、入院の上厳格な食事療法とインスリン量の調節を行った。血糖安定後、bolusインスリンを中止、基礎インスリンを減量し、ダパグリフロジンを追加した。CGMの結果、ダパグリフロジン導入前後のSD、MAGEに差がないことが示された。

　結論：SGLT2阻害剤の導入によって、bolusインスリンを中止した上に基礎インスリンをもとの約70%に減量し、BOTに切り替えることが可能であった。

   Objectives: In this report of 2 obese patients with type 2 diabetes, we propose the usefulness of basal-supported oral therapy (BOT) with sodium-glucose cotransporter 2 (SGLT-2) inhibitors, and a strategy to reduce the insulin dosage after improvement of glycemic control with intensive therapy.

   Case Reports: Two obese patients with type 2 diabetes, a 61-year-old female and a 37-year-old male, with poor glycemic control, were hospitalized, and strict diet and adjustment of insulin dosages were started. After blood glucose levels became stable, bolus insulin was discontinued, the dosage of basal insulin was reduced, and dapagliflozin was added. The results of continuous glucose monitoring (CGM) showed that there were no differences in the standard deviation (SD) or the mean amplitude of glucose excursion (MAGE) after introduction of dapagliflozin.

   Conclusions: Introduction of a SGLT-2 inhibitor made it possible to discontinue bolus insulin and switch to BOT with reduction of total insulin dosage.