Mechanisms of Ultrasound Neuromodulation Effects in Diabetes

Eligibility Criteria

• * Type 2 diabetic (T2D) subjects must be aged 18-80 and must be able to provide written informed consent
• * All subjects must have had T2D for at least 3 months prior to study enrollment. All subjects must be either on diet and exercise or oral antidiabetic agents alone, not on insulin or any form of insulin or GLP-1 receptor agonists.
• * Subjects must demonstrate:
• 1. A past medical history of abnormal glucose control and carry a diagnosis of T2D according to current ADA criteria:
• * A fasting plasma glucose (FPG) level of 126 mg/dL (7.0 mmol/L) or higher, or
• * A 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher during a 75-g oral glucose tolerance test (OGTT), or
• * A random plasma glucose of 200 mg/dL (11.1 mmol/L) or higher in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis or
• * A hemoglobin A1c (HbA1c) level of 6.5% or higher.
• 2. Be willing to carry a continuous glucose monitor for at least 10 days.
• 3. Be willing to follow all required instructions by study personnel and appear for the required laboratory assessments, including euglycemic clamps and OGTT.
• * BMI \>40kg/m2.
• * Untreated proliferative retinopathy
• * Creatinine clearance \< 60 ml/min/1.73 m2.
• * Serum creatinine ≥1.5 mg/dL
• * Positive pregnancy test, or presently breast-feeding, or failure to follow effective contraceptive measures
• * Active infection including hepatitis C, hepatitis B, HIV,
• * Any history of Active alcohol abuse
• * History of non-adherence to prescribed regimens
• * Baseline Hgb \< 10.5 g/dL in females, or \< 13 g/dL in males
• * History of coagulopathy or medical condition requiring long-term anticoagulant therapy (low-dose aspirin treatment is allowed)
• * Co-existing cardiac disease with active medication titration. Patients on stable meds without active cardiac complications permitted.
• * Liver function tests outside of 3xUL of normal range
• * GI disorders potentially interfering with the ability to absorb oral medications and h/o upper GI surgery that might have changed anatomy in the target areas.
• * Any medical condition or medication that, in the opinion of the investigators, will interfere with the safe completion of the study or study outcomes.