Diabetes mellitus (DM) is a growing problem among youth. Although type 1 (insulin-dependent) DM is a disease typically diagnosed during childhood or adolescence, estimates indicate that < or = 45% of new diabetes cases in children are type 2. Children with new-onset type 2 DM are often overweight, aged 10 years or older, have a family history of the disease, and are members of a racial/ethnic minority group. DM treatment has progressed greatly in recent decades. Inadequate therapy, urine testing, glycosylated hemoglobin levels of >10%, and high rates of diabetic complications that were common in the past have yielded to more effective treatments, accurate monitoring, and better outcomes. Insulin pumps and insulin analogues represent promising new avenues that have enhanced convenience, cost-effectiveness, patient satisfaction, and metabolic control of childhood DM.