 Clinical measures of adipose tissue mass BMI, waist circumference, waist-to-hip ratio do not adequately explain the inter-individual and ethnic heterogeneity in diabetes. . There is a need to identify noveluniversal markers of risk for diabetes DM and cardiovascular disease CVD. These biomarkers also can become additional outcome measures for an intervention such as pancreatickidney transplant. If biological markers show an improvement with an intervention before anthropometric changes occur, intermediate outcomes can be an encouraging finding for practitioners. This study will focus on the central question of adipose tissue dysfunction as mediator of metabolic complications of positive energy balance, independent of body fat content and distribution. This study will address the question of effect of hyperglycemia on adipose tissue function independent of body fat mass. This project will take advantage of unique expertise of our investigators to perform detailed metabolic studies in patients with diabetes who undergo pancreatickidney transplant. The results of the proposed study will provide support to the novel approach of identifying adipose tissue dysfunction, rather than obesity and fat distribution, as predictor of diabetes and CVD across all ethnic groups, age and gender. We will obtain necessary preliminary data for future grant submissions to support our central hypothesis and develop stronger interactions within and outside The University of Texas Medical Branch UTMB with clinical investigators in the area of DM and its complications. 