World's Second: China Unveils Domestic PEF Interventional Therapy for Over 140 Million Diabetes Patients

In an operating room at Shanghai Oriental Hospital in May 2026, a team led by Dr. Zhong Lan guided a catheter through the digestive tract of a type 2 diabetes patient. The tip of the device—a flexible electrode array designed to conform to the duodenum's curved anatomy—unfolded against the intestinal wall. Within minutes, controlled pulses of electrical energy were delivered to the target tissue. No bleeding. No complications. The patient's vital signs remained stable throughout.

The procedure marked the first clinical enrollment for China's first endoscopic pulsed electric field (PEF) system developed for type 2 diabetes, built by Shanghai-based Zhouling Medical. The company's technology approach ranks second globally, behind only the U.S. startup Endogenex.

The significance extends well beyond a single procedure. China is home to more than 140 million confirmed type 2 diabetes patients—roughly 25.5% of the global total, the highest in the world. For decades, treatment has relied on a combination of lifestyle changes and medication. But the drugs often lose effectiveness over time, and research shows that nearly 50% of patients on dual oral therapy still fail to reach glycemic targets. Uncontrolled blood sugar drives a cascade of complications: retinopathy, nephropathy, cardiovascular disease.

That reality has pushed researchers to look upstream—to the duodenum itself. Studies have shown that abnormal metabolic signals from the duodenal mucosa can drive insulin resistance. Resurfacing that tissue, the logic goes, could reset the metabolic cascade at its source.

A New Energy Platform

Earlier attempts at endoscopic duodenal ablation relied on radiofrequency or steam-based thermal energy—approaches that carried real risks of burning nearby pancreatic and biliary tissue, post-procedure bleeding, and intestinal strictures. Pulsed electric field ablation, by contrast, uses short bursts of high-voltage electricity to selectively destroy target cells without thermal damage. The technology has already proven itself in cardiac arrhythmia and tumor ablation.

Zhouling Medical's system uses a proprietary deployable flexible electrode catheter that expands to match the duodenum's natural curvature, covering the full target segment. An integrated smart energy feedback module adjusts ablation depth in real time. Before entering human trials, the company conducted extensive preclinical studies with Dr. Zhong's team. Animal models showed significant reductions in blood glucose and improvements in lipid profiles—data that supported the move to clinical enrollment.

A Market Taking Shape

The global market for pulsed electric field ablation products was valued at approximately USD 358 million in 2025 and is projected to reach USD 701 million by 2032, growing at a compound annual rate of about 10.1%, according to QYResearch. The expansion of PEF into metabolic diseases like diabetes and obesity could push that figure higher.

The rise of GLP-1 drugs—blockbuster injectables for blood sugar and weight control—has dominated diabetes headlines. But those therapies require ongoing injections, carry gastrointestinal side effects, and face a well-documented rebound problem once patients stop. A single endoscopic PEF procedure, by contrast, could deliver metabolic improvement lasting months to years. The two approaches are more complementary than competitive, covering patients who cannot tolerate drugs or resist long-term injection regimens.

For hospitals, the economics are straightforward: the procedure can be performed in existing endoscopy centers without dedicated surgical suites, with capital costs far below those of major surgical equipment.

Global Competition Heats Up

The benchmark remains Endogenex, a U.S. company whose ReCET system has received FDA breakthrough device designation. In March 2026, Endogenex closed a Series C extension of roughly RMB 350 million (approximately USD 48 million), bringing the total for the round to about RMB 900 million—evidence of strong investor conviction in the PEF-diabetes thesis.

In China, the minimally invasive metabolic intervention space is also drawing entrants. Companies including Tangji Medical and Xiaochuang Medical are pursuing multiple technology pathways, pushing the field from symptom management toward root-cause intervention.

Most of these domestic programs remain in early clinical validation. Zhouling Medical's first patient enrollment is not a finish line—but it is a milestone: a Chinese-developed metabolic intervention device moving from follower to differentiated innovator.

With China's massive patient base and rising policy support for diabetes prevention at the national level, the question is no longer whether device-based metabolic therapy will arrive—it is how quickly it can scale.