All patients received transcutaneous electrical nerve stimulation. Allsubsequent ttt will be 3 times per week for 12weeks .

Patients will also instructed to complete diary booklet each day to describe side effects corresponding with or temporally related to ttt.

The investigators checked all booklets at the 6 and 12 week assessments. The points for tvns are located in the auricular concha area where there is rich vagus nerve branch distribution.

Stimulation parameters will be 1MA of electrical current frequency of 20 HZ with pulse duration less than or equal 1ms ,administration once daily lasted 45 min the intensity adjusted based on the individual tolerance of patients.

Control group Sham tavns ttt location at the superior scapha , where no vagus nerve distribution, after final session, all baseline measurements will be repeated using the same procedures .

All data will be anonymized and stored securely .data will be verified by double _checked , and analysis by SPSS v26.

Sham TVNS 45 min for 3 months with dietary advices .

Tvns located at auricular concha area For 45min three times per week for 3 months.

Change in glucose tolerance assessed using 2_hours oral glucose tolerance test (OGTT), expressed as glucose plasma area under curve (AUC), following a75 g oral glucose load.

Change in insulin resistance assessed using homeostasis model assessment of insulin resistance (HOMA-IR), calculated from fasting plasma glucose tolerance test and fasting insulin levels.

Change in body mass index calculated as weight in kilograms divided by height in meter square (kg/m2).

Change in waist circumference measured in centimeters at the midpoint between the lowest rib and the ilkac crest