Pediatric Type 2 Diabetes Mellitus (T2DM) is an increasing medical concern for the pediatric community. It is most commonly diagnosed in adolescents but has also been seen in patients as young as 5 years of age. Presentation of T2DM can range from mild symptoms of polyuria, polydipsia and nocturia to diabetic ketoacidosis. Guidelines by the American Diabetes Association are used to diagnose and treat children with diabetes. Early diagnosis and aggressive treatment is critical in delaying complications of diabetes. Poorly controlled diabetes can lead to significant increase in morbidity and mortality with development of hypertension, nephropathy and retinopathy. In this chapter, a review of the epidemiology of Type 2 diabetes, diagnosis and treatment options will be discussed.