REN and Hyperinsulinemia: On a mechanistic level, obesity-driven insulin resistance and hyperinsulinemia increases sodium reabsorption from the renal tubules.97 In addition, hyperglycemia can lead to hypervolemia, increased sympathetic activity,97 and the activation of the renin-angiotensin-aldosterone system, which increases cardiac output and peripheral vascular resistance, leading to hypertension.97 The associations between obesity and hypertension in pediatric type 2 diabetes require further study.