Targeted Enteral Nutrient Delivery: A Prospective Randomized Study

Direct delivery of nutrient to the upper intestine by enteral feeding tube can increase
circulating levels of some glucose and appetite regulating hormones when compared to usual
oral ingestion. Such an enhancement could be of value in the management of type 2 diabetes
and obesity. In this study enteric-coated nutrients will be ingested to allow for direct
delivery of nutrient to the upper intestine. Levels of select hormones and glucose, and
measures of satiety and adverse effects will be compared following the ingestion of uncoated
and enteric coated nutrient.

Inclusion Criteria:

- 18-65 years of age

- BMI >27kg/m2

- Type 2 diabetes with known duration of <10years

- On metformin, sulfonylureas, thiazolidinedione or SGLT2 inhibitor or lifestyle
management alone or in combination only for management of type 2 diabetes

Exclusion Criteria:

Conditions

- Known foregut pathology or prior foregut surgery.

- Previous surgical treatment for obesity (excluding liposuction if performed > one year
before trial entry)

- Known cardiovascular disease other than controlled hypertension

- Known proliferative retinopathy or maculopathy requiring acute treatment, as judged by
the Investigator

- Known untreated or uncontrolled hypothyroidism/hyperthyroidism

- History of chronic pancreatitis or idiopathic acute pancreatitis

- Obesity induced by other endocrinologic disorders (e.g. Cushing Syndrome)

- Cancer (past or present except basal cell skin cancer or squamous cell skin cancer),
which in the Investigator's opinion could interfere with the results of the trial

- Use of insulin, DPP4 inhibitors or GLP-1 analogs in the previous 1 month

- Treatment with any antidiabetic agent(s) other than metformin, sulphonylurea
thiazolidinedione or SGLT-2 inhibitors in the 1 month prior to screening

- Use of any drug (except for metformin, sulphonylurea or thiazolidinedione or SGLT-2
inhibitors), which in the Investigator's opinion could interfere with glucose level
(e.g. systemic corticosteroids)

- Receipt of any other anti-diabetic investigational drug within 1 month prior to
screening for this trial, or receipt of any investigational drugs not affecting
diabetes within 1 month prior to screening for this trial

- Current or history of treatment with medications that may cause significant weight
gain, within 1 month prior to screening for this trial, including systemic
corticosteroids (except for a short course of treatment, i.e., 7- 10 days), tri-cyclic
antidepressants, atypical antipsychotic and mood stabilizers (e.g., imipramine,
amitryptiline, mirtazapin, paroxetine, phenelzine, clorpromazine, olanzapine,valproic
acid and its derivatives, and lithium) thioridazine, clozapine,

- Currently using or have used within three months prior to screening for this trial:
pramlintide, sibutramine, orlistat, zonisamide, topiramate or phenteremine (either by
prescription or as part of a clinical trial)

- Simultaneous participation in any other clinical trial of an investigational drug

- The receipt of any investigational product within four weeks prior to screening for
this trial Herbal supplements or over-the-counter medications

- Diet attempts using herbal supplements or over-the-counter medications within 1 month
prior to screening into this trial Other

- Milk allergy

- Lactose intolerance Language barrier, mental incapacity, unwillingness or inability to
understand and be able to complete the study Females of childbearing potential

- Pregnant breast-feeding or intend to become pregnant or are not using adequate
contraceptive methods (adequate contraceptive measures as required by US: abstinence
and the following methods: diaphragm with spermacide, condom with spermacide (by male
partner), intrauterine device, sponge, spermacide, Norplant®, Depo-Provera® or oral
contraceptives.