The incidence of type 2 diabetes has increased dramatically over the past 5 years, especially among minority youth. This article reviews the epidemiology of type 2 in pediatrics, including currently identified risk factors, insulin resistance as a condition preceding the development of diabetes, screening and classification guidelines, and current approaches to treatment. In addition, two concerns with the recent ADA guidelines are addressed: 1) The focus on identification of overt diabetes rather than identifying at-risk youth with the goal of preventing progression to diabetes; and 2) reliance on obesity as a risk factor for diabetes screening. Finally, future research needs are identified, including population-based studies to clarify epidemiology and classification of diabetes in youth, practical screening approaches for at-risk youth, and studies of intervention outcomes at various stages of disease development.