A Preliminary Clinical Study Protocol for Evaluating the Efficacy and Safety of Pulse Electric Field Ablation Systems in Treating Adult Type 2 Diabetes Mellitus With Suboptimal Drug Control

Prior treatment

• Currently using a GLP-1RA or a dual GLP-6/GIP agonist.
• Previous gastrointestinal surgery that has altered the anatomical structure of the digestive tract or may limit duodenal resection, such as Billroth II, Roux-en-Y gastric bypass, gastric banding, or other similar procedures/diseases.
• Previous history of chronic or acute pancreatitis.
• Patients currently using P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) that cannot be discontinued within 7 days prior to surgery.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) must not be discontinued within 4 weeks after treatment. Alternative use of acetaminophen and low-dose aspirin is permitted.
• Systemic glucocorticoids (excluding topical, ocular, or inhaled formulations) were administered continuously for more than 12 days within 10 weeks prior to screening.
• Use medications known to affect gastrointestinal motility
• Individuals currently using weight-loss medications or over-the-counter weight-loss drugs.
• A history of blood donation or transfusion within 3 months prior to screening.
• Any of the following cardiovascular diseases occurred within 6 months prior to screening: acute myocardial infarction (AMI), cerebrovascular accident (stroke), or hospitalization due to congestive heart failure.

Other illness

• Diagnosed with type 1 diabetes mellitus.
• Severe diabetes-related complications such as diabetic ketoacidosis or hyperosmolar non-ketotic coma.
• Over the past two years, insulin of any type has been used for more than 1 month (excluding treatment for gestational diabetes mellitus).
• History of ≥1 severe hypoglycemic episode within the past 6 months (defined as requiring assistance from a third party).
• Known autoimmune diseases.
• A known history of upper gastrointestinal structural or functional disorders may impede device passage through the upper gastrointestinal tract or increase the risk of tissue injury during endoscopic procedures, including upper gastrointestinal strictures, esophageal-gastric varices, large diverticula, or other severe esophageal, gastric, or duodenal pathologies.
• History of gastroparesis.
• Acute gastrointestinal disease has occurred within the past 7 days.
• A history of irritable bowel syndrome, radiation enteritis, or other inflammatory bowel diseases such as Crohns disease and celiac disease is known.
• Unstable or paroxysmal arrhythmia.
• History of valvular heart disease or chronic heart failure (NYHA class III or IV).
• Individuals with known immunocompromised status, including but not limited to those who have undergone organ transplantation, chemotherapy, or radiotherapy within the past 12 months, those with clinically significant leukopenia, those who are positive for human immunodeficiency virus (HIV), or whose immune status makes them unsuitable for clinical trial participation as determined by the investigators.
• During the examination, do not implant any electronic devices that cannot be turned off (such as implantable cardiac pacemakers).
• Currently diagnosed with malignant tumor or with a history of malignant tumor within the preceding 5 years (excluding non-melanoma skin cancer that has received adequate treatment with no evidence of recurrence at least 3 months prior to the study intervention, or treated cervical carcinoma in situ with no evidence of recurrence at least 3 months prior to the study intervention).
• Binge eating disorder; a history or presence of severe, progressive, or uncontrolled renal, genitourinary, hematologic, endocrine, cardiac, vascular, pulmonary, rheumatic, neurological, psychiatric disorders, or metabolic disturbances; or any other psychological or physical condition deemed by the investigator to render the participant unsuitable for participation in the clinical trial.
• The patient is in critical condition or has an expected lifespan of less than 5 years.

Lab values

• Fasting serum C-peptide \<1 ng/mL (333 pmol/L).
• Active hepatitis or active liver disease, or an alanine aminotransferase (ALT) level\>3.0 times the upper limit of normal (ULN) as determined by the central laboratory during screening evaluation.
• Persistent anemia, defined as hemoglobin \<10 g/dL.
• Known hemoglobinopathies, hemolytic anemia or sickle cell anemia, or other known hemoglobin abnormalities that may interfere with HbA1c measurement.

Other

• Currently, vitamin K antagonists such as warfarin are being used, or oral anticoagulants (DOCA) that cannot be safely discontinued are being administered.
• Participate in any structured weight loss program or endoscopic weight loss intervention within 6 months after screening.
• There is secondary hypothyroidism or poorly controlled primary hypothyroidism (TSH levels exceed the normal range during screening).
• A duodenal or biliary stent is in place.
• Patients with contraindications to upper gastrointestinal endoscopy or intravenous anesthesia.
• Breastfeeding women.
• The participant is currently enrolled in another ongoing clinical trial.

• Ages 18-70.
• At least 6 months prior to enrollment, the patient must have been diagnosed with type 2 diabetes mellitus.
• The glycated hemoglobin level is 7.5%-10.5%.
• BMI 2 7-40 kg/m2.
• Patients who, within 12 weeks prior to screening, were treated with 2-3 oral hypoglycemic agents yet still had poorly controlled blood glucose levels, and could maintain the same medication regimen throughout the trial; or those whose blood glucose control was suboptimal despite lifestyle modifications.
• Stable body weight (defined as a weight change of \<5% within 5 weeks prior to screening)
• Donation of blood is prohibited during the trial participation period.
• The subject must sign an Informed Consent Form (ICF), demonstrating their understanding of the purpose and procedures required for this study and their willingness to participate.
• Be willing and able to comply with all requirements specified in the trial, including but not limited to completing the required assessments, adhering to the visit schedule, and complying with lifestyle restrictions.
• Fertile female subjects must have a negative urine pregnancy test result during screening and must use contraception throughout the study period.