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

The investigators will conduct a case-control study within a two-year, prospective observational cohort study of 500 prevalent cases of T2D diagnosed <18 years of age. The investigators will evaluate the primary BPS risk factors associated with prevalent albuminuria using a principal component analysis (PCA) of associations between primary exposure variables at enrollment. After confirming the relevant BPS factors in the PCA analysis, the investigators will utilize a structural equation modeling approach to confirm the developed model.

Inclusion criteria

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

Criteria for Diagnosis of T2D:

• 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) or
• Hemoglobin A1c value ≥ 6.5%
• 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

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