Across 92 diabetes-related Phase II–III trial records authorized in 2024–2026, EU site participation is concentrated in a small set of countries and recurring academic or specialist networks. Poland, France, Italy, Germany, Spain, and Sweden form the core operational footprint, while the most recurrent site networks are AP-HP in France, Steno Diabetes Center Copenhagen in Denmark, Ospedale San Raffaele in Italy, and several high-frequency ophthalmology, endocrinology, and diabetes-center groups.
The top 10 recurring site networks account for 45 site-entry mentions across the 92 included trial records. AP-HP leads with 9 mentions, followed by Steno Diabetes Center Copenhagen and Ospedale San Raffaele with 6 mentions each.
The site landscape is not only hospital-led; it mixes national academic networks, specialist diabetes centers, ophthalmology trial units, and commercial site networks. This suggests diabetes trial execution depends on indication-specific infrastructure rather than one single endocrinology site model.
The top 10 countries account for 534 site entries. Poland leads with 91 entries, followed by France with 86, Italy with 72, Germany with 58, and Spain with 55.
| Rank | Country | Site entries | Share |
|---|---|---|---|
| 1 | Poland | 91 | 17.0% |
| 2 | France | 86 | 16.1% |
| 3 | Italy | 72 | 13.5% |
| 4 | Germany | 58 | 10.9% |
| 5 | Spain | 55 | 10.3% |
| 6 | Sweden | 43 | 8.1% |
| 7 | Bulgaria | 38 | 7.1% |
| 8 | Hungary | 34 | 6.4% |
| 9 | Romania | 30 | 5.6% |
| 10 | Denmark | 27 | 5.1% |
Poland and France show the broadest operational density, but Italy, Germany, Spain, and Sweden remain strategically important because they appear across multiple diabetes subsegments: Type 1, Type 2, diabetic macular edema, neuropathy, and kidney-disease-linked diabetes records.
Among the top 10 participant-allocation countries, Poland contributes the largest planned participant footprint with 1,120 participants, followed by France with 908, Germany with 765, Italy with 742, and Spain with 561.
High participant allocations do not always mirror the highest site counts. Germany and Denmark show comparatively efficient participant concentration, while Poland and France combine both breadth and enrollment weight.
Type 2 diabetes is the largest segment with 31 of 92 records, or 33.7%. Type 1 diabetes follows with 24 records, or 26.1%. Complication-led trials, including diabetic macular edema, diabetic kidney disease, neuropathic pain, and diabetic foot ulcer, together account for 37 records, or 40.2%.
The portfolio is not limited to glucose control. A large share is complication-led, which explains why ophthalmology, nephrology, neurology, and wound-care sites appear beside classic endocrinology and diabetology centers.
The diabetes cohort is balanced: 45 of 92 records are Phase II, or 48.9%, and 47 of 92 are Phase III, or 51.1%. By authorization year, 2024 contributes 37 records, 2025 contributes 28, and 2026 contributes 27.
The near-even Phase II/III split indicates that EU diabetes infrastructure is supporting both proof-of-concept expansion and confirmatory development. This is important for site selection because some countries serve broad late-stage recruitment, while others appear repeatedly in specialist Phase II complication trials.
Site-entry mention means one listed site occurrence within a country-level trial geography record. CTIS means Clinical Trials Information System. CKD means chronic kidney disease. AP-HP means Assistance Publique–Hôpitaux de Paris. Phase II refers to mid-stage dose, safety, and preliminary efficacy development; Phase III refers to confirmatory late-stage development.