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The primary objectives of DISCOVERY are to: 1. Identify the physiologic drivers and other determinants of progression to youth-onset T2D by charting the course of changes in glycemia, β-cell function, insulin sensitivity, psychosocial, behavioral, and social determinants of health during this critical period of maturation 2. Inform approaches for precise prediction of which youth are at highest risk of developing T2D during this period. 3. Engage local and central stakeholders to play an active role in the study design and conduct, and provide feedback during follow-up.

Longitudinal studies are needed to identify early contributors to insulin resistance and β-cell dysfunction in youth with obesity, and to explore the interrelationships between the transition through puberty and the evolution of dysglycemia, particularly in the context of psychosocial factors, social determinants of health, and physiologic differences attributable to social factors vs. ancestry.