Study of Duodenal Mucosal RF Vapor Ablation in Subjects With Type-2 Diabetes Mellitus

Inclusion Criteria:

1. Men and non-pregnant women 18-65 years of age

2. Diagnosed with T2D for at least 3 years and less than or equal to 10 years

3. HbA1C of 7.5 - 10% (59-86 mmol/mol)

4. BMI ≥ 24 and ≤ 40 kg/m2

5. On a minimum of 1 stable oral anti-diabetic medications with no changes inmedication in the previous 3 months prior to study entry Note: For subjects onsulfonylurea (SU) glucose-lowering drugs for diabetes, the only SUs permitted in thestudy will be glipizide or glimepiride, and their doses below half maximum labeleddosing will not be an exclusion for study entry. Subjects unwilling to reduce thedose of SU at the run-in period will be excluded.

6. Agrees to use an additional glucose-lowering treatment (e.g., liraglutide, other OADwith the exception of glyburide), if recommended by the study Investigator in caseof persistent hyperglycemia.

7. Able to comply with study requirements and understand and sign the Informed ConsentForm

Exclusion Criteria:

1. Diagnosis of Type-1 Diabetes

2. History of diabetic ketoacidosis or hyperosmolar nonketotic coma.

3. Probable insulin production failure, defined as fasting C Peptide serum <1 ng/mL (333pmol/l).

4. Previous use of any types of insulin for >1 month (at any time, except for treatmentof gestational diabetes).

5. Current use of injectable medications for diabetes (insulin, GLP-1RA).

6. Current use of glyburide, a sulfonylurea (SU) glucose-lowering drug for diabetes.

7. History of severe hypoglycemia (more than 1 severe hypoglycemic event, as defined byneed for third-party assistance, in the last year).

8. Known autoimmune disease, including but not limited to celiac disease, duodenalCrohn disease or pre-existing symptoms of systemic lupus erythematosus, sclerodermaor other systemic autoimmune connective tissue disorder.

9. Previous GI surgery that could limit treatment of the duodenum such as Billroth 2,Roux-en-Y gastric bypass, or other similar procedures or conditions. (Priorlaparoscopic sleeve gastrectomy (LSG) will not be an exclusion)

10. History of chronic or acute pancreatitis.

11. History of diabetic gastroparesis.

12. Known active hepatitis or active liver disease.

13. Acute gastrointestinal illness in the previous 7 days.

14. Known history of severe irritable bowel syndrome, radiation enteritis or otherinflammatory bowel disease, such as Crohn's disease.

15. Known history of a structural or functional disorder of the esophagus that mayimpede passage of the device through the gastrointestinal tract or increase risk ofesophageal damage during an endoscopic procedure, including moderate-severe (Grade Cor D) esophagitis, dysphagia due to achalasia or stricture/stenosis, esophagealvarices, esophageal perforation, or any other disorder of the esophagus.

16. Upper gastrointestinal conditions such as active ulcers, polyps, varices,strictures, congenital or acquired duodenal telangiectasia

17. Current use of anticoagulation therapy (such as warfarin) that cannot bediscontinued for 7 days before and 14 days after the procedure.

18. Current use of P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) that cannot bediscontinued for 14 days before and 14 days after the procedure.

19. Unable to discontinue non-steroidal anti-inflammatory drugs (NSAIDs) duringtreatment through 4 weeks following the procedure. Use of acetaminophen and low doseaspirin is allowed.

20. Use of systemic glucocorticoids (excluding topical or ophthalmic application orinhaled forms) for more than 10 consecutive days within 12 weeks prior to thebaseline visit.

21. Use of drugs known to affect GI motility (e.g. Metoclopramide)

22. Use of weight loss medications such as Sibutramine (e.g. Meridia), Orlistat (e.g.Xenical), Phentermine or over-the-counter weight loss medications (prescriptionmedication)

23. Currently taking, or unable to stop taking dietary supplements or herbal agents,including vitamin C or multivitamins containing vitamin C at >500 mg per day,multivitamins containing biotin (vitamin B7), and supplements for hair, skin, andnail growth. Multivitamins not containing biotin are permitted.

24. Significant cardiovascular disease, including known history of valvular disease, ormyocardial infarction, heart failure, transient ischemic attack, or stroke within 6months prior to the Screening Visit.

25. Mean of 3 separate blood pressure measurements >180 mmHg (systolic) or >100 mmHg (diastolic).

26. Estimated glomerular filtration rate (eGFR) ≤ 60 ml/min/1.73m2 (estimated by MDRD).

27. Known immunocompromised status, including but not limited to individuals who haveundergone organ transplantation, chemotherapy, or radiotherapy within the past 12months, who have clinically significant leukopenia, who are positive for the humanimmunodeficiency virus (HIV) or whose immune status makes the participant a poorcandidate for clinical trial participation in the opinion of the investigator.

28. Active illicit substance abuse or alcoholism (>2 drinks/day regularly)

29. Active malignancy within the last 5 years (excluding non-melanoma skin cancers)

30. Women breastfeeding

31. Participating in another ongoing clinical trial of an investigational drug ordevice.

32. Any other mental or physical condition which, in the opinion of the studyinvestigator, makes the participant a poor candidate for clinical trialparticipation.

33. Critically ill or has a life expectancy <3 years

34. Use of heart pacemaker or other electronic device implants

35. General contraindications to deep or conscious sedation, general anesthesia, highrisk as determined by anesthesiologist (e.g., ASA score 4 or higher), orcontraindications to upper GI endoscopy.