The new definitions and classification of diabetes is discussed. An electronic literature search was done especially for randomized trials in management of maternal diabetes. However, because of the paucity of such trials the modern management we propose is still based on evaluative and retrospective evidence. Problems of type 2 diabetes specifically in the developing world are highlighted. Although the goals of the St Vincent declaration are attainable; in a practical setting (even in excellent centres) we fall far short of achieving perinatal mortality and fetal anomaly rates equivalent to the non-diabetic pregnant population. This is mainly due to lack of excellent pre-conceptional care for the future diabetic mother.