title: Pharmacologic treatment of type 2 diabetes: injectable medications.
abstract: OBJECTIVE
  To review the oral and injectable pharmacologic treatment options for type 2 diabetes.
  
  
  METHODS
  A literature search was conducted using PubMed electronic database for studies published in English between 1993 and September 2014. Search terms included diabetes mellitus, type 2 diabetes, and the individual name for each antidiabetic medication reviewed. In addition, manual searches were performed for cross-references from publications. Package inserts, United States Food and Drug Administration (FDA) Web site, Institute for Safe Medication Practices Web site, American Diabetes Association Web site and scientific session poster presentations, and individual drug company Web pages were also reviewed.
  
  
  METHODS
  This review focused on information elucidated over the past 10 years to assist prescribers in choosing optimal therapy based on individual patient characteristics. Studies leading to the approval of or raising safety concerns for the antidiabetic medications reviewed in this article were included.
  
  
  RESULTS
  In the past 10 years, there have been 4 novel oral antidiabetic medication classes and 10 new injectable agents and insulin products approved by the FDA for the treatment of type 2 diabetes as well as new information regarding the safety and use of several older antidiabetic medication classes. The distinctions were reviewed for each individual agent, and a comparison was completed if there was more than one agent in a particular therapeutic class. Using current information available, select investigational agents in phase III trials or with a pending new drug application were highlighted.
  
  
  CONCLUSIONS
  There are now 9 distinct oral pharmacologic classes and a variety of insulin and noninsulin injectable medications available for the treatment of type 2 diabetes. Metformin remains the first-line treatment option for most patients. When considering options for alternative or additional treatment, prescribers must weigh the benefits and risks using individual patient characteristics.
authors: Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA linda.tran5@va.gov.
authors: Linda
authors: L
authors: Tran
authors: Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA.
authors: Angela
authors: A
authors: Zielinski
authors: Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA.
authors: Arpi H
authors: AH
authors: Roach
authors: Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA.
authors: Jennifer A
authors: JA
authors: Jende
authors: Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA.
authors: Ann Marie
authors: AM
authors: Householder
authors: Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA.
authors: Emily E
authors: EE
authors: Cole
authors: Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA.
authors: Shuruq A
authors: SA
authors: Atway
authors: Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA.
authors: Melinda
authors: M
authors: Amornyard
authors: Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA.
authors: Mallory L
authors: ML
authors: Accursi
authors: Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA.
authors: Suzanna W
authors: SW
authors: Shieh
authors: Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA.
authors: Erin E
authors: EE
authors: Thompson
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D008687:Metformin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin
keywords: DPP4-I; GLP-1 agonist; SGLT2-I; TZD; U-500 regular insulin; biguanide; bile acid sequestrant; biphasic insulin; diabetes medications; diabetes mellitus; dipeptidyl peptidase 4 inhibitor; dopamine receptor agonist; glucagon-like peptide-1 agonist; insulin; intermediate-acting insulin; investigational agent; long-acting insulin; meglitinide; pramlintide; prandial insulin; rapid-acting insulin; review; short-acting insulin; sodium-glucose cotransporter 2 inhibitor; sulfonylurea; thiazolidinedione; type 2 diabetes; ultra-rapid-acting inhaled insulin; α-glucosidase inhibitor