AI-assisted lifestyle plan vs. tirzepatide for obesity with newly diagnosed type 2 diabetes

Inclusion Criteria:

1. Male or female participants aged 18 to 65 years.
2. Newly diagnosed type 2 diabetes mellitus, defined as diagnosis within 3 years and no use of glucose-lowering medications within the past 3 months. Diagnosis should meet the 1999 World Health Organization criteria, including at least one of the following: random plasma glucose ≥11.1 mmol/L, fasting blood glucose ≥7.0 mmol/L, 2-hour postprandial blood glucose ≥11.1 mmol/L, or HbA1c ≥6.5% and ≤10.0%. Participants without typical diabetes symptoms should have repeat testing for confirmation.
3. Body mass index ≥28 kg/m² and \<40 kg/m².
4. Willing to use effective contraception and have no pregnancy plan within 12 months after signing the informed consent form; female participants must have a negative pregnancy test at screening.
5. Able to communicate with the investigators, willing to comply with the study protocol, and voluntarily sign the informed consent form.

Exclusion Criteria:

1. Type 1 diabetes mellitus, type 2 diabetes requiring insulin treatment, or other specific types of diabetes.
2. Body weight change \>5% within 12 weeks before screening.
3. Pregnant or breastfeeding women.
4. Severe trauma, severe infection, or surgery within 1 month before screening that may affect glycemic control.
5. Severe cardiovascular or cerebrovascular events within 6 months before screening, including angina, myocardial infarction, arrhythmia, cerebral infarction, cerebral hemorrhage, or other clinically significant events.
6. History of acute or chronic pancreatitis, history of pancreatic injury, or amylase \>1.5 × upper limit of normal at screening.
7. Current or previous malignancy, except local basal cell carcinoma of the skin, carcinoma in situ of the cervix, or carcinoma in situ of the prostate; diagnosis of malignancy within 5 years before screening.
8. Personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2, or history of thyroid nodules.
9. Blood dyscrasia or any disease causing hemolysis or unstable red blood cells, or hemoglobinopathy that may affect HbA1c measurement.
10. History of organ transplantation or acquired or congenital immune system disease.
11. Schizophrenia or other psychiatric disorder that may interfere with participation in the study.
12. Unstable or treatment-requiring endocrine disease related to glycemic control, such as hyperthyroidism, acromegaly, or Cushing syndrome, as judged by the investigator.
13. Hypertension with systolic blood pressure \>150 mmHg and/or diastolic blood pressure \>90 mmHg after stable antihypertensive treatment.
14. Clinically significant abnormal gastric emptying, severe chronic gastrointestinal disease, diabetic gastroparesis, long-term use of medications directly affecting gastrointestinal motility, or history of gastrointestinal surgery.
15. Special dietary requirements or allergy to foods such as soy products or dairy products.
16. Use of medications affecting glucose regulation within 3 months before randomization, such as glucocorticoids, growth hormone, thyroid hormone, sex hormones, cyclosporine, or phenytoin.
17. Allergic constitution, defined as allergy to two or more categories of substances.
18. Fasting C-peptide \<0.81 ng/mL.
19. Calcitonin ≥50 pg/mL.
20. Abnormal laboratory results, including AST or ALT \>2.5 × upper limit of normal, bilirubin \>2.5 × upper limit of normal, triglycerides ≥5.7 mmol/L, estimated creatinine clearance \<60 mL/min using the Cockcroft-Gault formula, or clinically significant anemia with hemoglobin \<120 g/L in men or \<110 g/L in women.
21. Unstable proliferative retinopathy or maculopathy requiring urgent treatment within 1 year before randomization, or history of diabetic ketoacidosis, hyperosmolar nonketotic coma, or severe metabolic disorder causing neuropsychiatric dysfunction.
22. History or risk factors of epilepsy, syncope, cardiac arrest, arrhythmia, atrioventricular block, structural heart disease, torsades de pointes, hyperkalemia, hypokalemia, hypermagnesemia, hypomagnesemia, hypercalcemia, or hypocalcemia.
23. Active bacterial, viral, or fungal infection requiring hospitalization or intravenous antibiotic treatment.
24. Positive HBsAg, HCV antibody, HIV antibody, or Treponema pallidum antibody.
25. Positive urine drug screening and/or drug dependence.
26. Participation in another clinical trial within 3 months before enrollment or current participation in another drug or device clinical trial.
27. Any other condition that, in the investigator's opinion, makes the participant unsuitable for this study.