OBJECTIVES: CHOICE is an ongoing prospective, multi-country observational study designed to evaluate time to significant treatment change among adults with type 2 diabetes (T2D) initiating injectable therapy in routine practice, and describing baseline characteristics, clinical outcomes, and common adverse events over 24 months. Results presented are from 6-month data analyses of the German sample. METHODS: Data were collected at initiation of exenatide or insulin, and 3 and 6 months thereafter. RESULTS: In Germany, 848 patients (394 exenatide, 454 insulin) were enrolled. Multivariate logistic regression indicated that high BMI, hypoglycaemia and high triglyceride levels were associated with exenatide initiation, while increased age, high blood glucose levels and increased frequency of blood glucose monitoring were associated with insulin initiation. Significant treatment changes were made in 20.7% of exenatide-treated and 29.7% of insulin-treated patients; corresponding discontinuation rates of initiated injectable therapy were 15.5% and 4.1%. At 6 months, mean (SD) HbA1c change from baseline was –0.8% (1.4%) in the exenatide cohort (baseline 8.2%) and –1.6% (1.7%) in the insulin cohort (baseline 8.8%). 21.5% of patients initiating exenatide achieved an HbA1c of <6.5% and 42.5% of <7.0%. Corresponding values for patients initiating insulin were 17.7% and 41.7%, respectively. Mean body weight changes were –3.7kg in the exenatide cohort and +0.9kg in the insulin cohort. Gastrointestinal symptoms and hypoglycaemic episodes were reported by 19.7% and 2.3% of patients in the exenatide cohort, respectively, and 2.5% and 11.3% of patients in the insulin cohort. CONCLUSIONS: Differences between German patients who initiated insulin and exenatide appear to reflect recommendations of the German Diabetes Association and the German health care authorities, with exenatide favoured when weight is high and hypoglycaemia is experienced on oral therapy and HbA1c being only modestly raised. Treatment outcomes were consistent with results of clinical trials and both are important components of T2D care.