Choice of first injectable therapy in type 2 diabetes.

A variety of injectable therapies are now available for use in patients of type 2 diabetes mellitus, when metformin alone proves inadequate. These injectable therapies include basal insulins, glucagon-like peptide 1 receptor agonists (GLP1RA), co-formulations of basal insulin with GLP1RA, and premixed or co-formulated dual action insulins. This article helps choose appropriate first injectable therapy in a rational manner, and achieve glycaemic control in an efficient way. The discussion utilizes the pharmacokinetic and pharmacodynamic properties of various injectable drugs to match them with various clinical situations. It highlights a gluco-phenotypic approach, utilizing readily available anthropometric measurements, glycaemic patterns, and other bio psychosocial parameters, to create a simple model which facilitates correct choice of first injectable therapy in type 2 diabetes.