Type 2 diabetes is emerging as a significant health problem in children and adolescents. The disease usually develops in obese insulin-resistant youth with a typical pattern of lipid partitioning characterized by increased lipid deposition in myocytes, the visceral compartment, and the liver. Unfavorable adipocytokine profiles, together with a state of low-grade inflammation, create an additional metabolic burden tightly coupled to other components of the metabolic syndrome. Insufficient β-cell compensation promotes altered glucose metabolism.