Improving Renal Complications in Adolescents With Type 2 Diabetes Through REsearch Cohort Study (National iCARE Study) (iCARE)

Inclusion Criteria:

• All youth with T2D that do not meet exclusion criteria are eligible for the study.

Criteria for Diagnosis of T2D:

1. Diagnosis of diabetes will be made according to the Canadian Diabetes Association criteria. There must be 2 abnormal blood glucose tests on different days OR 1 abnormal blood glucose test + symptoms of diabetes:

   • Fasting plasma glucose of > 7.0 mmol/L or
   • Random glucose > 11.1mmol/L or
   • 2 hour glucose > 11.1 mmol/L after a standard oral glucose tolerance test (75g).

2. Distinguishing T2D from type 1 diabetes (T1D) will be based on clinical risk factors including:

   • Presence of overweight/obesity,
   • Other evidence of insulin resistance (acanthosis nigricans)
   • Family history of type 2 diabetes (1st degree relative)
   • Intrauterine exposure to hyperglycemia,
   • Family heritage from a high-risk ethnic group (Indigenous, Hispanic, South Asian, Asian or African descent)
   • Absence of diabetes associated auto-antibodies
   • HNF-1 alpha heterozygote or homozygote

Exclusion Criteria:

1. Diabetes secondary to medication use or surgery
2. Antibodies suggestive of type 1 diabetes
3. Current treatment with oral steroids or immunosuppressive agents as they may interfere with cortisol assessment and inflammatory markers
4. Ever cancer
5. Other chronic illness associated with systemic inflammation (ex. Juvenile rheumatoid arthritis, Crohns disease)
6. Patient and or caregiver unable or unwilling to provide voluntary informed assent/consent