Randomized Controlled Trial of Digital Twin Precision Treatment: A Novel Whole Body Digital Twin Enabled Precision Treatment for Type 2 Diabetes

Prior treatment

• Currently or in past 3 months receiving an anti-obesity medication or any other medication used for the primary intent of weight loss
• History of acute coronary syndrome, myocardial infarction, or stroke within the prior 12 months
• Current chronic corticosteroid therapy (≥ 5 mg of prednisone per day or an equivalent dose of other anti-inflammatory corticosteroids)
• Major surgical procedure or significant traumatic injury within 28 days prior to Enrollment Date

Other illness

• History of hospitalization (within the last 12 months) for diabetic ketoacidosis
• Any medical or surgical condition that the principal investigator considers making the patient unfit for the trial (e.g., psychiatric disorders, malignancy, etc.)
• History of Congestive Heart Failure
• Any condition, unwillingness, or inability, not covered by any of the other exclusion criteria, which, in the study clinician's opinion, might jeopardize the subject's safety or compliance with the protocol

Lab values

• HbA1C \>11%
• Type 1 diabetes, latent autoimmune diabetes in adults (LADA), maturity onset diabetes of the young (MODY), pancreatic diabetes, gestational diabetes mellitus, any secondary diabetes by clinical history, or fasting C Peptide \< 1 mmol/L or GAD-65 antibody positivity
• Inadequate hepatic function as measured by AST/ALT \> 3.0 x ULN
• Inadequate renal function as measured by eGFR \< 30 mL/min/1.73 m2

Other

• Patients who have undergone or are planning for any bariatric procedure
• Pregnant, planning pregnancy in the next 12 months and lactating/nursing females
• Mental incapacity or language barrier
• Excessive alcohol intake (defined as self-reported greater than or equal to 3 drinks per day)
• Patients who do not have any insurance (government or commercial) coverage at the time of enrollment to avoid confounders in data

• Men and women between ages 18 and 75
• Self-reported duration of Type 2 diabetes less than or equal to 15 Years
• Own smartphone and compatible with TPT and sensors (iPhone and android)
• Baseline HbA1c of ≥ 7.5% and ≤ 11% or baseline A1c ≥ 6.5% but \< 7.5% on any glucose lowering medication (inclusive of Metformin). For patients with a baseline A1c of \< 6.5%, the patient must be on at least one glucose lowering medication with or without Metformin.
• BMI: ≥ 27 Kg/2
• NAFLD Fibrosis Score \> -1.00 to be screened and enrolled for additional subset MRE evaluation (optional for patient to consent to MRE evaluation) of liver steatosis/fibrosis (30 patients from TPT group and 15 patients from the Usual Care group)