Electrical Vestibular Nerve Stimulation (VeNS) Compared to Sham Control As a Means of Improving Glycemic Control in Adults with Type 2 Diabetes Mellitus

Prior treatment

• Taking beta-blockers (if previously then can enroll if off ≥ 30 days).
• Taking insulin (if previously on insulin then should be off for ≥ 90 days prior to enrolment).
• Either of the following within the previous year: myocardial infarction; or acute coronary syndrome.
• Change in diabetic medication within the last 90 days (prior to enrolment).
• Regular use (more than twice a month) of antihistamine medication within the last 6 months. Note: If the participant is taking Fexofenadine, they can be eligible for the trial. If the participant is on another anti-histamine medication they can voluntarily opt to switch to Fexofenadine and enrol in the trial after a washout period of 2 weeks.
• Current use of H2-receptior antagonist medication? (e.g., cimetidine, famotidine)
• Previous use of Modius device
• Use of any medication (e.g. hormonal modulators or corticosteroids) that could cause iatrogenic T2DM. (NB Topical steroid use is acceptable if judged by PI to be unrelated).

Other illness

• Diagnosis of Type 1 diabetes mellitus
• Skin breakdown, eczema or other dermatological condition (e.g. psoriasis) affecting the skin behind the ears. Any disorder which in the investigator's opinion might jeopardize subject's safety or compliance with the protocol.
• History of pancreatitis
• History of pancreatic surgery
• History of stroke
• History of epilepsy
• History of anemia (if resolved for \> 90 days with treatment then can enroll)
• A diagnosis of a hemoglobinopathy (e.g. sickle cell disease and thalassemia, although those with sickle cell or thalassemic trait would be allowed to enroll);
• If on dietary supplements or herbal remedies, then if the subject is taking a preparation that might affect glycemic control they will be excluded. Specifically, subject will be excluded if taking biotin (vitamin B7); alpha-lipoic acid; chromium; herbal preparations marketed as being for diabetes.
• History of being diagnosed with renal, heart or liver failure
• History of active migraines with aura
• History of head injury requiring intensive care or neurosurgery.
• History or presence of malignancy within the last year (except basal and squamous cell skin cancer and in-situ carcinomas)
• A diagnosis of myelofibrosis or a myelodysplastic syndrome.
• History of vestibular dysfunction or other inner ear disease (as assessed on the screening questionnaire)
• Failure to pass the ATMAS Flex hearing test
• Failure to demonstrate a willingness for lifestyle modification (i.e diet and exercise) if BMI is ≥25 (as assessed on the screening questionnaire)
• Failure to agree to weekly engagements with the Clinical Trial Mentors during trial participation
• Failure to agree to use of device daily during trial participation (no more than 2 weeks usage drop without reasonable explanation)
• Any other medical condition, or medication use, that in the opinion of the PI/CI is likely to make the subject refractory to VeNS.

Lab values

• Blood transfusion within 90 days of enrolment (due to effect on HbA1c). (If transfusion occurs once enrolled then subject will be withdrawn).

Other

• Diagnosis of diabetic neuropathy
• Diagnosis of diabetic nephropathy
• Diagnosis of retinopathy
• Female who is pregnant, breast-feeding or intends to become pregnant or is of child-bearing potential and not using an adequate contraceptive method (adequate contraceptive measure as required by local regulation or practice)
• Hemochromatosis
• Splenectomy (due to effect on red blood cell turnover)
• Participation in other clinical trials sponsored by Neurovalens (e.g. Vestal study)
• Presence of permanently implanted battery powered medical device or stimulator (e.g., pacemaker, implanted defibrillator, deep brain stimulator, vagal nerve stimulator etc.)
• Have a member of the same household who is currently participating in this study.

• Informed consent obtained before any trial-related activities. Trial-related activities are any procedures that are carried out as part of the trial, including activities to determine suitability for the trial.
• Male or female, age ≥ 22 years and ≤ 70 years at the time of signing informed consent. (At the US sites). The non-US sites will recruit subjects aged ≥ 18 and ≤ 70 years.
• Diagnosed with Type 2 DM ≥ 90 days prior to day of enrolment
• HbA1c (glycated hemoglobin) ≥ 6.5 and ≤ 9.5% (48-80 mmol/mol) (both inclusive).
• If taking medication to treat diabetes, a stable dose of no more than 3 anti-diabetic medications for at least 90 days prior to enrolment.
• BMI ≥ 25 at non-US sites
• Must be under care of physician for follow-up of their type 2 DM (this can be a Primary Care Physician (PCP), endocrinologist or other hospitalist).
• Must agree to continue to participate with their routine diabetes care program.
• Access to Wi-Fi.