Abstract:  The comorbidities of type 2 diabetes in children and adolescents are mainly related to coexistent insulin resistance and compounded by poverty. The prevalence of dyslipidemia, fatty liver, and hypertension may not be higher than the rates in obese children and adolescents, but the stakes are higher in children with diabetes because the diabetes confers a higher cardiovascular risk. This risk is exaggerated further in children with poor hygiene, smoking, and primary renal disease. Sexuality, contraception, preconception counseling, and psychiatric conditions require unique considerations in youth with type 2 diabetes.