Real-World Effectiveness Begins With Real-World Populations
InSites Issue 3, written by Dr Nick Probert, Medical Director and Lead PI, explores the shifting conversation around GLP-1 therapies - in ways that matter directly to trial design.
Dr Nick Probert
Published 31 March 2026
Clinical research
GLP-1 therapies are often still framed as weight loss interventions. From where I sit in clinical research, that framing is becoming outdated.
What we are seeing is broader: cardiometabolic improvement, better glycaemic control, emerging signals across cardiovascular health, and early indications in areas we are only beginning to explore. Weight loss may be what brings patients into the conversation. But it is just the start.
The approval of oral semaglutide has shifted that conversation again - and in ways that matter directly to trial design. Patients who had stepped away, particularly those who did not want injectable treatments, are returning. Not just asking about treatment, but asking about trials. These are not the same patients we were seeing before. They tend to have more complex health profiles, longer histories of disengagement from healthcare, and more limited prior interaction with research environments.
For sponsors planning long-duration GLP-1 studies, that shift in the eligible population is a design consideration, not just a recruitment one.
"Long-duration GLP-1 studies do not typically fail at recruitment. They struggle in the middle - when participation stops being theoretical and becomes something that has to fit into everyday life."
Designed to be Meaningfully Different
Traditional site models tend to work from a fixed patient base. Fixed sites have fixed reach. If the population you need is not already within that catchment, recruitment becomes harder and less representative - and your dataset narrows before a single endpoint is reached.
A community-based model changes that dynamic. At EMS Healthcare, sites are placed where eligible populations actually live, not on existing infrastructure. They are also designed around the studies they run: spaces that feel different from hospital environments, in some cases shaped with direct patient input, in locations that reduce travel time and financial burden. These are not incidental features: precise environmental differences have a measurable impact on whether participants feel comfortable returning - and return visits are where long-duration studies succeed or fail.
Accessibility is not a Secondary Consideration
For many patients living with obesity - particularly those with associated comorbidities - accessing care is already complex. Adding a research protocol on top of that increases the barriers further. When those barriers are not anticipated in trial design, friction tends to appear at a predictable point: when visit schedules begin to conflict with work or caring responsibilities, when travel burdens and accessibility exceed what participants had expected, when a clinical environment feels unwelcoming.
Obesity remains one of the few conditions where patients routinely internalise failure as personal rather than physiological. By the time someone reaches a clinical trial, that history is already present. It shapes trust, engagement, and ultimately whether they stay. Retention strategies that do not account for this are fragile by design.
Underserved communities are typically those with the highest disease burden. When they are missing from the dataset, the evidence base becomes narrower than the reality it is meant to represent and importantly, that gap surfaces later in real-world outcomes, adherence rates, and long-term effectiveness data.
A Community Network 25 Years in the Making
One of the consistent lessons from delivering both pre- and post-approval studies across the UK is that recruitment does not begin at site activation. It begins much earlier, through established relationships with GP practices, ongoing engagement with local communities, and a genuine understanding of how patients typically access care and why they do not.
With over 25 years of community presence, EMS Healthcare holds that infrastructure already. It is not something that can be replicated quickly for a single study. It is what enables access to populations that are otherwise consistently underrepresented in clinical research and what makes retention in long-duration studies structurally more robust.
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Each month, we'll share InSites drawing on over two decades of supporting communities across the UK, what's worked, what we've learned, and what we're seeing in the evolving research landscape.
InSites Issue 3 is written by Dr Nick Probert, Medical Director and Lead PI at EMS Healthcare.