I've done it well in C projects by tackling it at build time. Compile each test separately and use the dependencies of the test to decide what to link against, so if the test has "#include <mock-thing.h>" then that gets translated to link against mock-thing.o which implements all the functions from thing.h (the interface) plus some ways to manipulate the state. Basically compile time dependency injection. I think this is a fairly language independent way to handle things.

By relying on make for the heavy lifting the tests are completely incremental, only tests that depends on modified files get run. It also doesn't pollute the run time code with layers of indirection.