The prevalence of diabetes, especially that of type 2 in children, is increasing at an alarming rate worldwide. Although no data currently exists to determine the extent to which type 2 diabetes has emerged among U.S. children and adolescents, researchers at the Centers for Disease Control and Prevention estimate that among new cases of childhood diabetes, the proportion of those with type 2 diabetes ranges between 8 percent and 43 percent.1 Over the last 20 years, the prevalence of type 2 diabetes has increased sharply. Prior to the 1990s, documented rates of type 2 diabetes ranged between 1 and 4 percent for adolescents. However, many centers have reported increases in the incidence of type 2 diabetes in children each year of the past decade. In some pediatric populations, the rates of type 2 diabetes now exceed those of type 1.2 Type 2 diabetes is usually diagnosed in patients over the age of 40 while type 1 diabetes typically affects juveniles. However, this distinction has started to blur as more and more adolescents have been diagnosed with type 2. Type 2 diabetes begins when the body develops a resistance to insulin and no longer uses the insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce sufficient amounts of insulin to regulate blood sugar. Children who develop type 2 diabetes are typically overweight or obese and have a family history of the disease. In addition to obesity, type 2 diabetes is often characterized by the metabolic syndrome of hyperglycemia, dyslipidemia and insulin resistance. This syndrome is similar in both adults and children diagnosed with type 2 diabetes. For such children, the problems go beyond diabetes itself and include its complications.3 The rate of complications, such as heart disease, kidney disease, blindness and stroke, increases with the length of duration of diabetes.1 With an earlier onset of diabetes, more and more patients are suffering greater rates of these complications. One study has addressed the significant overall increase in the percentage of children referred with new-onset diabetes who were considered to have type 2 diabetes in Florida.4 Several additional papers have addressed this epidemic as the prevalence of type 2 diabetes rises among children and adolescents.2,5 Why Are More Children Developing Type 2 Diabetes? The increase in type 2 diabetes mellitus among children appears to occur in populations that have high rates of the disease among adults. This was noted initially among Pima Indians, a group that has the highest rates of type 2 diabetes in the world. Pima Indian children have higher rates of type 2 than the general population and the rates increase with age. Between the late 1980s and the mid-1990s, the rates of diabetes among adolescent Pima Indians increased 54 percent. Although two decades ago, children who had been diagnosed with type 2 diabetes were found almost exclusively in selected population groups such as the Pima Indians, the problem is spreading. In some clinics, as many as 21 percent of diabetic children of Mexican-American ethnicity have type 2 diabetes. Other clinics have reported that 69 percent of pediatric patients who had type 2 were African-American. Today, although most children with type 2 are American Indian, African-American, Asian or Hispanic/Latino, type 2 diabetes has also been diagnosed more and more frequently in children in all races and ethnic groups.1 What is causing the increased prevalence? Trends in the prevalence of obesity and physical inactivity among children may help to explain the increasing rates of type 2. Large population-based surveillance studies demonstrate increases in the rates of overweight and obesity among all age groups since the 1960s. Rates of overweight and obesity among children are epidemic in parts of the United States. Although this observation does not explain the rise in type 2 diabetes completely, the weight trends parallel the trends of type 2 diabetes among children.2 One of the major issues facing healthcare is the logarithmic association between the risk of complications with increasing glycemia, which has been established for adults with type 2 diabetes, and whether this is likely to hold true for children.