High penetrance of kidney anomaliesCritical for the function and development of kidneys (3)Strong correlation between hyperglycemia and insulin resistance and pathogenic variants (24)Large deletion of the BBS9 gene can lead to the development of a more severe BBS phenotype (e.g., osteopenia with pathological fractures leading to disability, kidney and liver failure, behavioral disorders) and the development of T2DM (10). Here, BBS9 is linked to Insulin resistance.