Lifestyle Therapy for Youth With Type 2 Diabetes (BDT)

• Glycemic control determined by a standard fasting measure of glycosylated hemoglobin using internationally recognized DCCT assay [ Time Frame: 16 weeks ] [ Designated as safety issue: No ]
  

• Cardiometabolic risk Z score [ Time Frame: 16 weeks ] [ Designated as safety issue: No ]
  This is a composite score based on BMI z-score, waist circumference, c-reactive protein (CRP), fibrinogen, low density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol, triglycerides (TG) and apolipoprotein B (apoB), and a marker of fatty liver disease, alanine transaminase (ALT)
  
  
• Presence of microalbuminuria [ Time Frame: 16 weeks ] [ Designated as safety issue: No ]
  defined as a first morning albumin:creatinine ratio (ACR) 2.5-25 mg/mmol in a first morning urine collection
  
  
• Hypertension [ Time Frame: 16 weeks ] [ Designated as safety issue: No ]
  defined as a systolic blood pressure load >25% or a mean 24 hour systolic blood pressure >95th %ile for sex and height on 24 hour ambulatory blood pressure monitoring
  
  
• Anthropometrics [ Time Frame: 16 weeks ] [ Designated as safety issue: No ]
  Waist circumference in centimeters, body mass index (BMI) z-score and percent body fat will be assessed to determine if changes in body composition are associated with improvements in cardiometabolic risk
  
  
• Cardiovascular structure and function [ Time Frame: 16 weeks ] [ Designated as safety issue: No ]
  Vascular health will be assessed with non-invasive assessments of arterial stiffness, endothelium-dependant relaxation and carotid intima media thickness which will be treated as continuous variables. Left ventricular structure and function will be assessed using standard M-mode and doppler ultrasound techniques
  
  

Youth between the ages of 10-20 years living with type 2 diabetes and not currently on insulin therapy will be randomly assigned to either a lifestyle intervention group or a control group. The lifestyle intervention group will meet 2-3 times per week for 16 weeks to take part in healthy living education sessions involving physical activity, healthy cooking, healthy gardening and how to start and sustain a healthy lifestyle change. At the beginning and end of the 16 weeks the investigators will measure the participants' blood sugars, height, weight, cholesterol, triglycerides and liver enzymes. The investigators will also take a picture of their kidney, heart and blood vessels using ultrasound. Those youth assigned to the control group will receive the 16 week intervention following their 16 week control period.