To provide an overview of type 2 diabetes in children and discuss short-term and long-term management strategies.We review the distinction among various types of diabetes mellitus as they apply to children. In addition, we discuss determining the precise diagnosis between the two major variants--type 1 and type 2 diabetes--and clinical management of type 2 diabetes in children.A dramatic increase in the incidence of type 2 diabetes in children has been noted, which is commensurate with an overall increase in obesity. In Arizona, this trend has been similar to that reported in Ohio and Arkansas. Glucose toxicity of the pancreas, which occurs with chronic hyperglycemia and impairs insulin secretion, may lead to manifestation of florid diabetic ketoacidosis and requires insulin therapy at diagnosis. For successful long-term management of type 2 diabetes in a child, a program that includes weight reduction must be implemented.Obesity-related diabetes is increasing at an alarming rate in children. Physicians responsible for the care for pediatric patients should be aware of this trend and should become familiar with management strategies for type 2 diabetes.