title: Challenging recruitment of youth with type 2 diabetes into clinical trials.
abstract: OBJECTIVE
  To better understand and overcome difficulties with recruitment of adolescents with type 2 diabetes into clinical trials at three United States institutions, we reviewed recruitment and retention strategies in clinical trials of youth with various chronic conditions. We explored whether similar strategies might be applicable to pediatric patients with type 2 diabetes.
  
  
  METHODS
  We compiled data on recruitment and retention of adolescents with type 2 diabetes at three centers (National Institutes of Health, Bethesda, Maryland; Baylor College of Medicine, Houston, Texas; and Children's National Medical Center, Washington, DC) from January 2009 to December 2011. We also conducted a thorough literature review on recruitment and retention in adolescents with chronic health conditions.
  
  
  RESULTS
  The number of recruited patients was inadequate for timely completion of ongoing trials. Our review of recruitment strategies in adolescents included monetary and material incentives, technology-based advertising, word-of-mouth referral, and continuous patient-research team contact. Cellular or Internet technology appeared promising in improving participation among youths in studies of various chronic conditions and social behaviors.
  
  
  CONCLUSIONS
  Adolescents with type 2 diabetes are particularly difficult to engage in clinical trials. Monetary incentives and use of technology do not represent "magic bullets," but may presently be the most effective tools. Future studies should be conducted to explore motivation in this population. We speculate that (1) recruitment into interventional trials that address the main concerns of the affected youth (e.g., weight loss, body image, and stress management) combined with less tangible outcomes (e.g., blood glucose control) may be more successful; and (2) study participation and retention may be improved by accommodating patients' and caregivers' schedules, by scheduling study visits before and after working hours, and in more convenient locations than in medical facilities.
authors.affiliation: Section on Pediatric Diabetes and Metabolism, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: Tammy T
authors.initials: TT
authors.lastname: Nguyen
authors.affiliation: Section on Pediatric Diabetes and Metabolism, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: Vikas
authors.initials: V
authors.lastname: Jayadeva
authors.affiliation: Section on Neuroendocrinology of Obesity, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cizza
authors.affiliation: Section on Pediatric Diabetes and Metabolism, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Brown
authors.affiliation: Division of Endocrinology, Children's National Medical Center, Washington, DC.
authors.forename: Radha
authors.initials: R
authors.lastname: Nandagopal
authors.affiliation: Section of Endocrinology and Metabolism, Baylor College of Medicine, Houston, Texas.
authors.forename: Luisa M
authors.initials: LM
authors.lastname: Rodriguez
authors.affiliation: Section on Pediatric Diabetes and Metabolism, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland. Electronic address: kristina.rother@nih.gov.
authors.forename: Kristina I
authors.initials: KI
authors.lastname: Rother
mesh_terms: D000293:Adolescent; D002648:Child; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2; D006801:Humans; D008722:Methods; D009042:Motivation; D018579:Patient Selection; D012959:Socioeconomic Factors; D014481:United States
keywords: Adolescents; Clinical trials; Pediatric; Recruitment; Retention; Type 2 diabetes; Young adults; Youth