Recommendations for insulin initiation based on ethnicity.

Even in a developed country like USA, substantial number of subjects with type 2 diabetes fail to achieve adequate glycemic control despite the availability of several groups of anti-diabetic medications targeting multiple pathophysiological features of type 2 diabetes. Are we treating our type 2 diabetes subjects appropriately? To aid practicing clinicians various professional bodies like American Diabetes Association (ADA), European Association for Study of Diabetes (EASD), Canadian Diabetes Association (CDA), etc. regularly publish clinical practice guidelines and consensus statements. Since racial and ethnic differences in insulin resistance, dietary pattern, glucose metabolism, genetic variation are known phenomena, it would be interesting to evaluate the aptness of these guidelines from ethnopharmacy perspective. We postulate that certain ethnic characteristics of populations will decide the best form of insulin therapy rather than blanket recommendations on starting every patient on basal insulin.