Mass General - Division of Clinical Research

Screening will occur to enrich the yield of individuals who are highly predisposed to develop youth-onset T2D and include those with all of the following criteria: - Overweight or obesity with BMI ≥85th percentile - Age 8-13 year for girls, 9-15 year for boys (inclusion younger for girls as puberty tends to start a year earlier in girls) - Tanner Stage 2, 3, or 4 - Elevated HbA1c 5.5-6.4%

An individual who meets any of the following criteria will be excluded from participation: - Diabetes based on history, or HbA1c ≥6.5% in the medical record or at screening - Unable/unwilling to provide consent/participate fully - Conditions predisposing to diabetes or altering the trajectory of puberty - Medications affecting glucose dynamics during the screening and enrollment period - Prior treatment with insulin - Use of glucagon-like peptide-1 (GLP-1) receptor agonist or any weight loss medications in the 6 weeks prior to enrollment - Planning treatment with glucagon-like peptide-1 (GLP-1) receptor agonist or any weight loss medications - Use of metformin or any glucose lowering medication for a reason other than treatment of diabetes (e.g., for PCOS) in the 6 weeks prior to enrollment - Planning treatment with metformin or any glucose lowering medication or planning to use such medications for a reason other than treatment of diabetes (e.g., for PCOS) - Known syndromic/monogenic obesity - Blood disorders impacting HbA1c (e.g., anemia, hemoglobin variants) - Major systemic organ disease - History of bariatric surgery or currently planning bariatric surgery - Current pregnancy or currently planning pregnancy - Use of GnRH agonist, estrogen, or testosterone - Individuals who do not speak English or Spanish, given validation of the questionnaires to be utilized