“Nothing can ruin your study faster than if your volunteers are not compliant and you can’t retain them.” This was the central message from Dr Trisha Shamp, VP Medical Operations and US principal investigator at Nucleus Network, during a recent GlobalData-hosted webinar on how sponsors can deliver complex cardiometabolic clinical trials in an increasingly competitive development landscape.

The webinar Excellence in Cardiometabolic Clinical Trials brought together Dr Shamp and Dr Graham Wood, PhD, Chief Scientific Officer at Nucleus Network, to examine the operational realities of one of the busiest areas of drug development. As obesity, diabetes, cardiovascular disease, metabolic dysfunction-associated steatotic liver disease (MASLD) and GLP-1-related pipelines continue to expand, early-phase trial execution is under increasing pressure.

GlobalData analysis presented during the session showed that phase two cardiometabolic trial activity rose from 255 studies in 2016 to 433 in 2025, an increase of ~70%. The same data also showed that 50.8% of cardiometabolic trial sites are now in phase one, while 20.8% are in phase two. However, this growth is creating new challenges, with sponsors now increasingly looking for sites that can combine rapid recruitment with complex assessments, including insulin sensitivity testing, indirect calorimetry, DEXA, MRI, FibroScan and other specialist procedures. In the webinar, GlobalData noted that screen failure rates above 80% are now routine in some cardiometabolic studies.

Resolving recruitment challenges

The webinar presented real-life case studies, including an MASLD programme that required participants to meet eligibility criteria based on MRI-PDFF and FibroScan results. Screening involved four separate visits and pharmacodynamic assessments at baseline and across a 12-week enrolment period. Early screening also showed a 90% screen failure rate, driven by factors such as FibroScan results, MRI criteria, BMI ranges, alcohol use, drug and nicotine screens, and HbA1c values. Over 16 weeks, Nucleus Network was able to enrol 80 participants.

The second study highlighted involved participants on stable GLP-1 therapy who had lost 10% of their body weight and were looking to discontinue treatment. The programme also required layered screening and complex pharmacodynamic assessments. Over 14 weeks, Nucleus Network enrolled 68 participants.

The webinar also explored how Nucleus Network uses recruitment infrastructure to create a feedback loop across marketing, recruitment, screening and clinical research teams. This approach enables teams to see where participants enter or leave the funnel, identify failure patterns and adjust campaigns while studies remain active. “It really comes down to gathering all the data and then making sure that data is communicated across the team,” explained Dr Wood.

However, retention and compliance depend on building trust early, explaining expectations clearly and maintaining consistent communication throughout the participant journey. This hands-on model helped drive 96% compliance across key study activities and more than 94% retention.

Where to watch

The full webinar, including how Nucleus Network was able to achieve these results, is available to view on demand and offers a practical look at cardiometabolic trial delivery beyond headline recruitment numbers. It explores Nucleus Network’s approach to feasibility, campaign optimisation, participant engagement, imaging partnerships, pharmacodynamic assessments and site-level execution, drawing on two recent case studies.