Impact of Metabolic Surgery on Pancreatic, Renal and Cardiovascular Health in Youth With Type 2 Diabetes

Exclusion Criteria

• •Obesity or T2D onset (diagnosis) \> 18 years of age
• •Prepubertal
• •Anemia
• •For participants undergoing the optional Parts 2-4 of visits 2 and 4, seafood or iodine allergy
• •Pregnancy or breastfeeding
• •Claustrophobia, implantable devices (MRI contraindications)
• •Recent diabetic ketoacidosis or hyperosmolar hyperglycemia
• •Other causes of diabetes other than T2D
• •For participants undergoing the optional Parts 2-4 of visits 2 and 4, diuretics, sodium-glucose co-transport (SGLT) 2 or 1 blockers, daily NSAIDs or aspirin, sulfonamides, procaine, thiazolsulfone or probenecid, atypical antipsychotics or regular use of oral steroids
• •Evidence of bleeding disorder or complications from bleeding
• •Use of aspirin, NSAIDS or other blood thinner that cannot be safely stopped for a sufficient time period before and after the biopsy so as to add no additional risk of bleeding
• •Blood urea nitrogen (BUN) \> 80 gm/dL
• •INR \> 1.4
• •PTT \> 35 seconds
• •Hemoglobin (Hgb) \< 10 mg/dL
• •Platelet count \< 100,000 / µL
• •Uncontrolled or difficult to control hypertension (\> 150/90 mmHg at the day of biopsy)
• •eGFR \< 40 mL/min/1.73m2
• •Single kidney (either by history, documented by prior imaging or ultrasound performed prior to the biopsy)
• •\> 2 cm discrepancy between left and right kidney sizes based on largest longitudinal diameter determined by ultrasound performed prior to the biopsy.
• •Kidney size: One or both kidneys \< 9 cm
• •Hydronephrosis or other important renal ultrasound findings such as significant stone disease
• •Any evidence of a current urinary tract infection as indicated on day of biopsy
• •Clinical evidence of non-diabetic renal disease
• •Positive urine pregnancy test or pregnancy